DEFINITION (1)Cirrhosis can be simply defined as diffuse fibrosis associated with parenchymal nodules. It affects the entire liver rather than a small part, although occasionally the fibrosis may be more severe in one or the other. lobe. Fibrosis results in part from the collapse of new fiber formation and is generally considered to be a consequence of liver cell necrosis. The nodules of a cirrhotic liver are the surviving parenchyma. But they are structurally modified. They vary greatly in size and appearance. Within them there may be little organized structure similar to normal lobules and acini. In biliary cirrhosis and hemochromatosis, the parenchyma remains normal for a long time and fibrosis is the dominant pathological process. But true cirrhosis occurs only when the lobular architecture is altered.3 CHANGES IN LIVER CELLS (1) The most common change is necrosis of liver cells. It may be acute hepatitis or viral or alcoholic type. Alternatively, there may be ongoing damage to liver cells, as in metabolic disorders. When necrosis is massive, as in severe viral or drug-induced hepatitis, surviving areas of parenchyma are thought to undergo regeneration but fail to reproduce normal lobular or acinar architecture. The compressed necrotic areas then constitute the basis of the fibrous partitions of the cirrhotic liver. In biliary cirrhosis and hemochromatosis, the eventual transition to cirrhosis is likely to...... middle of paper ...... Coagulation process spread by the coagulation cascade• Cessation of coagulation by mechanisms antithrombotics• Removal of the clot by fibrinolysisThe liver plays a central role in each of these phases of the coagulation process, because it synthesizes the majority of coagulation factors and proteins involved in fibrinolysis as well as thrombopoietin., which is responsible for production of platelets from megakaryocytes. In cirrhosis, the liver is severely damaged. The production of coagulation factors and proteins is therefore impaired. Many disease processes associated with cirrhosis, such as portal hypertension and endothelial dysfunction, as well as comorbid conditions, can also impair the coagulation process. Therefore, patients with liver disease, such as cirrhosis, have a disrupted balance between procoagulant and anticoagulant factors that deviates from the normal coagulation cascade...