Chronic Hepatitis

Question 1

Definition and aetiology of chronic hepatitis

Answer 1

~Symptomatic, microscopic, biochemical or serological evidence of hepatic disease > 6months

Aetiology
~ virus: chronic hepatitis C (most common), B (young age, maternal to infant transmission), D+B
~ others: autoimmune hepatitis, drug induced, Wilson’s disease, cryptogenic

Question 2

Morphology of chronic hepatitis

Answer 2

Gross:
Early - normal
Late - firm (fibrosis) —> macronodular cirrhosis

Micro :
~ portal inflammation- limited to portal tracts -L, M, P
~ interface hepatitis- piece meal necrosis/ Periportal necrosis : spillover of inflammatory cells into adjacent parenchyma - apoptosis of periportal hepatocytes
~Parenchymal inflammation and necrosis- bridging necrosis between portal tracts
~ fibrosis: initially only in portal tracts, later periportal fibrosis - bridging fibrous septa - portal to portal

Question 3

Clinical features and consequences of chronic hepatitis

Answer 3

~ fatigue, malaise, loss of appetite, mild jaundice
~ spider angiomas, Palmar erythema, mild hepato-megaly, hepatic tenderness, mild splenomegaly

ConSequences
~ cirrhosis - irregular size nodules / broad, fibrous scars : post, necrotic cirrhosis
~macronodular / mixed

Question 4

Laboratory findings of chronic hepatitis

Answer 4

Biochemical:
~ serum aminotransferase: mild to moderate elevated
~ serum alkaline phosphatase: normal or marginally elevated
~ serum BiliRubin: normal or raised
~ serum proteins: hypoalbuminaemia
~ prothrombin time: prolonged

Serological
~ positive HbsAg
~ positive IgG anti- Hbc, negative IgM anti- Hbc
~ positive HbeAg
~ positive HBV DNA

URINE
~ BiliRubin increased
~ urobilinogen increased