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Cirrhosis thus represents an in many respects nonspecific end stage characterized by disturbance of the hepatic circulation, expressed in portal hypertension and reduction of the effective parenchymal circulation, which latter accounts, often more than the loss of parenchyma, for impaired hepatic function. The disturbance of the circulation produces the complications and is the main target of symptomatic medical and surgical management, The diagnosis and parti- cularly the distinction from the often overlapping chronic hepatitis are based greatly on liver biopsy. The pathogenesis involves (a) hepatocellular necrosis, for which today a rational therapy does not exist, reflected in the results of hepat:ic tests, (b) regeneration which, if abnormal, is related to cancer, (c) inflammation, the localization of which offers indications for antiinflammatory therapy, and (d) fibroplasia, which may become a target of therapy and a reflection of progression. The various etiologic factors produce clusters of similar morphologic pathways which are best identified by characteristics of the precursor lesion.
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