chronic hepatitis

By/Asmaa Eisa Ghazy Mohamed MaraeeNo./182Round/2

Chronic hepatitis indicates a persistent, and often progressive, necroinflammatory process of the liver lasting more than 6 months and is characterized histologically by lymphocytic infiltration of the portal tracts together with varying degrees of parenchymal inflammation, hepatocellular injury, and fibrosis.

Definition

chronic hepatitis has been divided on morphologic grounds into three groups

• Chronic hepatitis with piecemeal (periportal) necrosis (or interface hepatitis) with or without fibrosis.

chronic active hepatitis

• chronic hepatitis with no significant periportal necrosis or regeneration with a fairly dense mononuclear portal infiltrate

chronic persistent hepatitis

• chronic hepatitis with persistent parenchymal focal hepatocyte necrosis (apoptosis) with mononuclear sinusoidal infiltrates.

chronic lobular hepatitis

discrimination by differences in prognosis.

chronic persistent

hepatitis and chronic

lobular hepatitis

chronic

active

hepatitis

uncomplicated portal inflammation and

pronounced lobular inflammation respectively, were considered benign, nonprogressive lesions

aggressive hepatocellular necrosis

and fibrosis, was regarded as a serious, progressive process leading to cirrhosis

autoimmune disease

CAUSES

Viruses

Fatty infiltration

inherited metabolic disorders

reactions to medications

Alpha 1-antitrypsin deficiencyAlcohol

Symptoms

Asymptomatic or have only minor complaints

others exhibit features of chronic liver disease or

hepatic failure

The disease may have an insidious onset or may present abruptly; occasionally it follows an episode of acute hepatitis that fails to remit

The most common symptoms include

fatigue or malaise, with mild abdominal discomfort, jaundice, anorexia, fever, nausea, or arthralgias

Extrahepatic manifestations amenorrhea, acne, gynecomastia, or Cushinoid changes

Physical examination findings

hepatomegaly, mild splenomegaly, and, occasionally, spider angiomas or palmar erythema

Unfortunately, the clinical findings are not specific and correlate poorly with the severity of the disease.

The characteristic laboratory

abnormalities include

increase, usually of two- to 10-fold, in serum transaminase levels

Other liver tests are generally normal or only mildly abnormal; increasing serum bilirubin, falling albumin levels, and a prolonged prothrombin time signal advanced, progressive disease

Liver biopsy assessment in chronic hepatitis

liver biopsy provides the best information available concerning the amount of hepatic fibrosis and the amount of ongoing inflammation and necrosis

Inflammation (Grade)

Grade Description Piecemeal Necrosis

Lobular Inflammation and Necrosis

0 No activity None None

1 Minimal Minimal, patchy Minimal; occasional spotty necrosis

2 Mild Mild; involving some or all portal tracts

Mild; little hepatocellular damage

3 Moderate Moderate; involving all portal tracts

Moderate; with noticeable hepatocellular damage

4 Severe Severe; may have bridging fibrosis

Severe, with prominent diffuse hepatocellular damage

Degree of fibrosis (Stage)Stage 0: no fibrosisStage 1: enlarged fibrotic portal tractsStage 2: periportal fibrosis or portal to portal septa, without architectural distortionStage 3: bridging fibrosis with architectural distortion, no obvious cirrhosisStage 4: cirrhosis (probable or definite)

Suggestive Histologic Findings

Liver Immunohistochemistry Definitive Diagnosis

Hepatitis B Ground-glass cells HBsAg, HBcAg HBsAg, HBeAg, HBV-DNA, HBcAg in liver

Hepatitis C Fatty change, Sinusoidal inflammation, Lymphoid follicles, Bile duct damage

none Anti-HCV, Clinical history

Hepatitis D none HDV antigen Anti-HDV, HDV-RNA, HDV antigen in serum or liver

Autoimmune-Associated

none none Autoantibodies,Serum immunoglobulins

Drug-Induced none none Drug history

Wilson's Disease Copper accumulation, Fatty change, Glycogenated nuclei

none Serum ceruloplasmin, Quantitative copper studies

Alpha-1-Antitrypsin Deficiency

PAS-positive cytoplasmic globules Alpha-1-antitrypsin Serum levels and phenotyping

The etiology is established through

prognosis