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1
Q

VIRAL HEPATITIS

reserved for infection of the liver caused by a small group of viruses having a particular affinity for the liver?
Systemic viral infections ?

A

Hepatitis viruses A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV).
Hepatitis G virus (HGV) is not pathogenic

Systemic viral infections that can involve the liver include:
1) infectious mononucleosis (Epstein-Barr virus), → mild hepatitis
2) Cytomegalovirus particularly in the newborn or immunosuppressed;
3) yellow fever,

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2
Q

VIRAL HEPATITIS
CLINICOPATHOLOGICAL TYPES

A

1- Asymptomatic acute infection:
- Identified accidentally by : mild ↑ in serum aminotransferases &(serologic evidence only)
presence of antiviral Antibodies
2- Acute viral Hepatitis: Caused by HAV, HEV, HBV, or ± HCV.
(AST= aspartate aminotransferase, GOT?) (ALT= alanine aminotransferase, GPT √√)
3- Fulminating Hepatitis: Caused by HEV, HAV, HBV, submassive to massive hepatic necrosis with acute liver failure
4- Chronic Hepatitis: Caused by HCV, HBV, HDV
with or without progression to cirrhosis, persistent elevations of serum aminotransferase levels.
5- Chronic carrier: caused mainly by HBV, or ± HCV.
- an individual without manifest symptoms who harbors & so can transmit an organism.
(asymptomatic without apparent disease)

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3
Q

Acute viral Hepatitis:

Four phases:

A

1- Incubation period:
2- Preicteric phase:
- nonspecific constitutional symptoms as:
- malaise, fatigability, nausea, loss of appetite
, - low-grade fever, headaches, muscle and joint aches
3- Icteric phase:
- Jaundice appears (mainly conjugated hyperbilirubinemia),
→ yellowish sclera, dark-colored urine (dt conjugated bilirubin), light colored stools (due to cholestasis), pruritis (due to retention of bile salts),With hepatocellular damage → consequent defect in bilirubin conjugation,
so, unconjugated hyperbilirubinemia can also occur.
- Enlarged tender liver
- Elevated serum aminotransferase levels
4- Convalescence: jaundice & most symptoms disappear in few weeks
Peak of infectivity: during last days of incubation period & early days of acute symptoms

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4
Q

Acute viral Hepatitis Gross, Microscopy, Fate

A

Gross: Liver is enlarged and reddened; ± greenish if cholestatic
Microscopy: - Hydropic (ballooning) degeneration of hepatocytes.
- Necrosis of hepatocytes: isolated cells or clusters obtain
- Inflammatory cells (lymphocytes, macrophages) around necrotic cells, in sinusoids & in the adjacent portal tracts.
- Cholestasis: bile plugs in canaliculi & bile inside the cytoplasm of hepatocytes
- Framework of the liver is not affected.

Fate: acute viral hepatitis may terminate by one of three possibilities:
1- Complete recovery in 95% or more as in hepatitis A infections.
2- Acute fulminating hepatitis: may occur with HEV (during pregnancy), HAV & HBV)
3- Chronic hepatitis or chronic carrier: may occur with HCV, HBV.

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5
Q

Fulminant Viral Hepatitis

Pathology

A

There is severe necrosis which may be massive affecting most of the hepatic parenchyma, or submassive (less severe).
1- Acute Massive Necrosis: - Diffuse liver cell necrosis → The patient dies in few days due to liver failure.
2- Subacute Massive Necrosis:
- The patient dies within few weeks from liver failure or may rarely survive longer and develop post-necrotic cirrhosis.

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6
Q

Chronic Viral Hepatitis

Definition Etiology, C/P

A

Chronic inflammation viral liver disease manifested clinically and serologically for more than 6 months
Etiology: most common: HCV, HBV, HDV
C/P: fatigue, malaise, loss of appetite, bouts of mild jaundice. spider angiomas, palmar erythema, mild hepatomegaly, hepatic tendernessand

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7
Q

Chronic Viral Hepatitis

Laboratory studies:

A

persistent elevations of serum aminotransferase levels,
 prolongation of the prothrombin time and, in some instances,hypergammaglobulinemia,
 hyperbilirubinemia, and mild elevations in alkaline phosphatase levels

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8
Q

The major causes of death in patients with chronic hepatitis

A

cirrhosis, namely, liver failure, hepatic encephalopathy, massive cirrhosis
hematemesis from esophageal varices, and hepatocellular carcinoma

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9
Q

Chronic Viral Hepatitis Microscopic Features:

A

1- lnflammation: - mainly lymphocytes in portal tracts, but may extend to periportal are area causing necrosis of periportal hepatocytes (= Piecemeal necrosis or Interface hepatitis)
2- Necrosis of hepatocytes:
- It may be piecemeal necrosis or in severe cases multiacinar or bridging necrosis) connecting portal-to-portal, central-to-central, or portal-to-central regions of adjacent lobules, signifying a more severe form of acute hepatitis.
3- Fibrosis: (range absent to very marked). - It may be portal fibrosis → periportal fibrosis → followed with time by bridging fibrosis → finally resulting in cirrhosis, with fibrous septa and hepatocyte regeneration nodules.
4- Other Features:
- Ballooning of hepatocytes. - Fatty change of hepatocytes - Ground glass hepatocytes (in case of HBV)
- Cholestasis (in severe cases)
- Hepatocellular dysplasia (precancerous)

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10
Q

Grading and staging of Chronic Hepatitis - Using:

A

1- Scoring system for the Grade (degree) of necro-inflammatory activity & 2- Scoring system for Stage of fibrosis.
Grading & staging correlate with prognosis and response to interferon therapy

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11
Q

Types Of Chronic Hepatitis (Old Classification)

A

1- Chronic Persistent Hepatitis:
- mild portal inflammation (mainly lymphocytes) and there is No or minimal necrosis.
2- Chronic Active (Aggressive) Hepatitis:
- there is portal and lobular inflammation, Necrosis, Fibrosis

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12
Q

Complications Of Chronic Hepatitis:

A

1- Post hepatitic cirrhosis.
2- Liver failure. 3- Hepatocellular carcinoma.

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13
Q

LIVER ABSCESS

Etiology

A

In developing countries liver abscesses usually result from Parasitic infections:
- Amebic liver abscess: cause: Entamoeba histolytica
- lnfected hydatid cyst: cause: Echinococcus granulosus

Western world, liver abscesses usually result from Bacterial infections:
- complicating ascending cholangitis: E coli → usually multiple
- Blood spread (portal or systemic pyaemia) → Pyaemic abscesses, multiple glsolitary multiple
- direct spread to the liver from a nearby source, → usually solitary
- Following a penetrating injury.→ usually solitary

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14
Q

Gross , C/P: LIVER ABSCESS

A

Gross:
- May be solitary or multiple, ranging from few millimeters to massive lesions - consisting of necrotic tissue with abundant neutrophils. ± Bacteria, fungi or parasites
C/P: fever with right upper quadrant pain and tender hepatomegaly ± Jaundice

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