This document discusses chronic hepatitis, which is hepatic inflammation and necrosis that continues for at least 6 months. It can be classified by cause such as hepatitis B, C, autoimmune hepatitis, or drug-associated hepatitis. It can also be classified by grade based on the extent of necrosis and inflammation visible on biopsy. Chronic hepatitis B has varying likelihood of chronicity depending on age at infection and may present asymptomatically or with fatigue, jaundice, ascites, or bleeding varices. Laboratory findings include elevated liver enzymes and hypoalbuminemia. Chronic hepatitis B clinical forms are differentiated based on presence of HBeAg and levels of ALT and HBVDNA.

1. CHRONIC HEPATITIS Hepatic inflammation and necrosis continue for at least 6 months Classification: cause, grade, stage

2. By Cause Hepatitis B Hepatitis B and D Hepatitis C Autoimmune Hepatitis Drug-associated chronic hepatitis Cryptogenic hepatitis

3. By Grade Piecemeal necrosis – periportal necrosis and disruption of the limiting plate Bridging necrosis –confluent necrosis that forms bridges between portal tracts and central vein Degree of hepatocyte degeneration Portal inflammation Scoring Indices: HAI, METAVIR

4. Table 300-2

5. Table 300-2

6. Chronic Viral Hepatitis Hepatitis A and E – no chronic forms Hepatitis B Hepatitis C Hepatitis B with superimposed Hepatitis D

7. Chronic Hepatitis B Likelihood of chronicity varies with age Infection at birth: clinically silent but 90% chance of chronic infection In adults: acute infection associated with clinical symptoms but risk of chronicity is 1% Liver injury: absent (carriers), mild , moderate, severe

8. Survival Rates 5 Years Mild 97% Moderate-severe 86% Cirrhosis 55% 15 Years Mild 77% Moderate-severe 66% Cirrhosis 40%

9. CHB: Clinical features Broad: asymptomatic  debilitating  end stage hepatic failure Fatigue, anorexia Jaundice (persistent, intermittent) Ascites, edema Bleeding varices, encephalopathy, coagulopathy, hypersplenism

10. CHB: Laboratory Features Elevated bilirubin levels Elevated ALT/AST Alk Phos – marginally elevated Hypoalbuminemia Prolongation of Prothrombin time

11. Lab: hepatitis B markers HBsAg Anti HBs HBeAg: viral replication, infectivity, liver injury AntiHBe HBVDNA viral load

12. Clinical Forms of Hep B HBeAg + CHB: ALT & HBVDNA elevated HBeAg – CHB: ALT & HBVDNA elevated (pre-core mutants Hepatitis B carrier: ALT normal; HBVDNA low or undetectable