Difference Between Piecemeal Necrosis and Bridging Necrosis

The term "necrosis" is used to describe the process through which a cell dies and becomes nonfunctional. In humans, cell death is a natural process, but it can cause serious injury if it happens too quickly or in the wrong places. In both short-term and chronic liver illnesses, necrosis is a common complication.

Due to the chronic nature of the liver disease, fibrosis develops along with necrosis throughout the liver. Necrosis shows itself in distinctive patterns that tell doctors a lot about the health of a patient's liver.

Necrosis in the liver can take two forms: piecemeal necrosis, also called interface hepatitis, and bridging necrosis, sometimes called confluent necrosis. Bridging necrosis relates more to the location in the liver where cell loss is occurring, whereas piecemeal necrosis is linked to a degenerative impact on cells. These forms of necrosis are both acute and chronic manifestations of serious illness consequences linked to a variety of hepatic (liver) disorders.

The distinction between piecemeal and bridging necrosis will be explored in further depth in this article.

What is Piecemeal Necrosis?

Interface hepatitis is another name for piecemeal necrosis. Steatohepatitis, autoimmune hepatitis, and viral hepatitis are all linked to this necrosis. The physiological basis for this necrosis is the progressive weakening or complete elimination of the sliver's limiting plate of cells.

Inflammatory processes with eroding consequences are ultimately involved, and the action takes place at the lobular-portal interface. Here you can see the connection between the portal tracts and the liver parenchyma.

Potential Causes − Necrosis that occurs in pieces is typically associated with long-term autoimmune hepatitis and chronic viral hepatitis.

Clinical Presentation and Diagnosis − Hepatocytes cluster together in a layer at the portal touch in biopsies, indicating the presence of piecemeal necrosis. That's also a symptom of chronic hepatitis, and it's often followed by fibrosis in the next stage of the disease.

Blood testing can also reveal autoimmune antibodies when hepatitis is caused by autoimmune mechanisms and causes piecemeal necrosis. Necrosis can strike isolated portal regions or spread over the whole portal.

What is Bridging Necrosis?

Another name for bridging necrosis is confluent necrosis. In particular, vascular structures are affected by this necrosis. The centrilobular veins (terminal hepatic venules) and their connection to the liver portal tracts are key components in bridging necrosis of the liver. Necrosis that spreads across many liver lobe zones is an example of bridge necrosis.

Potential Causes − Most cases of bridging necrosis are brought on by a severe case of acute viral hepatitis. Injuries to the liver, including those caused by drugs and alcohol, can also result in bridging necrosis.

Clinical Presentation and Diagnosis − Bridging necrosis can be observed under the microscope when a cell sample has been taken (biopsied) and colored. There will be a noticeable absence of collagen deposition in the cells, and even less original portal tract collagen will be present at a later stage. Cell investigations will also show that the reticulin scaffolding has collapsed in the necrotic areas and that elastic fibers that should have been deposited there are absent.

Differences between Piecemeal Necrosis and Bridging Necrosis

The following table highlights the major differences between Piecemeal Necrosis and Bridging Necrosis −

Conclusion

Liver diseases can develop as either piecemeal necrosis or bridging necrosis. Bridging necrosis is more commonly linked with acute liver injury, but it can also occur in long-term hepatitis, although piecemeal necrosis is more commonly associated with chronic types of hepatitis including autoimmune hepatitis.

Bridging necrosis in vascular systems like centrilobular veins and hepatic portal tracts causes piecemeal necrosis at the lobular-portal interface in the liver.