A 54-year-old man dies from profuse upper gastrointestinal hemorrhage. An autopsy is performed; gross examination of his liver is shown in the image below. This patient's liver findings most likely resulted from which of the following processes?

Question

A 54-year-old man dies from profuse upper gastrointestinal hemorrhage.  An autopsy is performed; gross examination of his liver is shown in the image below.  This patient's liver findings most likely resulted from which of the following processes?

Quizplus · Accepted Answer

Cirrhosis, the end stage of many chronic liver diseases, is characterized by diffuse hepatic fibrosis with replacement of the normal lobular architecture by fibrous-lined regenerative parenchymal nodules. This gives the liver a nodular appearance on gross examination. The most common causes of cirrhosis include chronic viral hepatitis (eg, hepatitis B and C), alcohol, hemochromatosis, and nonalcoholic fatty liver disease. Portal hypertension, from increased resistance to hepatic blood flow, typically develops in advanced cirrhosis and can lead to development of gastroesophageal varices. Untreated, these varices are prone to rupture and can result in a massive gastrointestinal hemorrhage and possibly death. (Choice A) Dilation of sinusoids and perivenular hemorrhage are associated with acute venous outflow obstruction affecting the liver (eg, Budd-Chiari syndrome). Chronic hepatic vein obstruction is a rare cause of cirrhosis and portal hypertension. (Choice C) Granulomatous destruction of bile ducts is seen in patients with primary biliary cholangitis (PBC). Although PBC can cause cirrhosis, it is a far less common cause than alcohol or chronic hepatitis. Moreover, PBC primarily occurs in women. (Choice D) Intrahepatic hydatid cysts with surrounding fibrous reaction can be seen in patients with an Echinococcus infection, but it is a very rare disease in the United States. (Choice E) Pigment accumulation within hepatocytes occurs in conditions such as Dubin-Johnson syndrome, an autosomal recessive disorder causing conjugated hyperbilirubinemia. In this condition, hepatocellular accumulation of coarse pigmented granules causes the liver to appear grossly black. Educational objective: Cirrhosis is characterized by diffuse hepatic fibrosis with replacement of the normal lobular architecture by fibrous-lined parenchymal nodules. Chronic viral hepatitis (eg, hepatitis B and C), alcohol, hemochromatosis, and nonalcoholic fatty liver disease are the most common causes of cirrhosis in the United States.

A 54-Year-Old Man Dies from Profuse Upper Gastrointestinal Hemorrhage