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Advanced and End Stage Liver Disease (Cirrhosis)

Many disease processes including viral infections, autoimmune disease, and alcoholic or non-alcoholic steatohepatitis lead to fibrosis or scarring of the liver which, if extensive enough, can lead to liver failure and/or portal hypertension. Chronic liver disease with fibrosis is also a common precursor to the development of hepatocellular carcinoma. Determining the degree of fibrosis in a liver biopsy is done using the trichrome stain. The biopsy size is critical for an accurate assessment of the fibrosis. In general, at least 1.5 cm of liver is considered the minimal amount needed for accurate staging. The reticulin stain is also useful in determining if the advanced liver disease known as "cirrhosis" has developed. Often, the regenerative nodules in this condition will show thickened cell plates that can only be seen on the reticulin stain.