pathology of chronic hepatitis for nursing students

1. BY-
RAMYA DEEPTHI
VIJAY MARIE COLLGE OF NURSING

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.