2. Definition
Chronic hepatitis is defined as continuing or relapsing
hepatic disease for more than 6 months, with presence
of symptoms and other diagnostic parameters-
serology, biochemical and histopathology.
3. Etiology
Usually due to hepatitis B, C, or a combined hepatitis B, D
Non viral causes-
1. Wilson disease
2. Antitrypsin deficiency
3. Chronic alcoholism
4. Impaired immunity
5. Extremes of age
Chronic hepatitis is a carrier state where the individual
harbors and replicates virus, hence can transmit the
organism.
4. Clinical features
Common features are-
Fatigue
Loss of appetite
Mild jaundice
Raised serum transaminases
Lab findings reveal liver cell injury
5. Morphology
MICROSCOPY: histological features of chronic hepatitis ranges
from mild to severe.
1. PIECEMEAL NECROSIS:
piece by piece necrosis around the portal tract, infiltration
of lymphocytes, plasma cells and macrophages.
6. 2. INTRALOBULAR LESION:
Focal area of necrosis and inflammation are seen in adjacent
areas of liver parenchyma called interface hepatitis.
These have scattered acidophilic body and kupffer cell
hyperplasia.
7. 3. BRIDGING FIBROSIS:
Initially portal tract and later periportal areas exhibit fibrosis
followed by linking fibrous septa between lobules causing
disarray of the architecture.
8. Activity score
Evolved to assess the activity of chronic hepatitis based on
the histomorphology as follows.
a. Necrosis: periportal bridging- score ranges from 0-10
0- no necrosis
10- multilobular necrosis
b. Inflammation: depth/ extent. Score ranges from 0-4
0- no inflammation
4-marked portal inflammation
c. fibrosis: density/ extent. Score ranges form 0-4
0- no fibrosis
4- resembles cirrhosis
9. Based on activity score chronic
hepatitis is further classified into -
Chronic persistent hepatitis- mild activity
Chronic lobular hepatitis- mild to moderate fibrosis
Chronic active hepatitis- moderate to severe fibrosis.
10. IV. CARRIER STATE
Individual with out symptoms but harboring infection with
hepatotrophic virus and is capable of transmitting
infection to others is called carrier state.
Hepatitis A and E do no produce carrier state.
Hepatitis B is mostly responsible for all carrier cases in the
world.
It is detected by HBsAg in the serum.
Morphology:
Carrier on biopsy do not show any changes on liver.
They show granular ground glass eosinophilic cytoplasm as
evidenced by HBsAg.
11. V. FULMINANT HEPATITIS
It is most severe form of acute hepatitis seen within 2-3
weeks of onset of symptoms and progress to fulminate
hepatic failure.
2 patters are seen-
1. Sub fulminate- has a less rapid course, and 3extends
up to 3months
2. Fulminate type: it has 2 etiological agents-
a. Viral- usually HBV, HAV, HCV and rarely HBV HDV.