BY-

RAMYA DEEPTHI

VIJAY MARIE COLLGE OF NURSING

Definition Chronic hepatitis is defined as continuing or relapsing

hepatic disease for more than 6 months, with presenceof symptoms and other diagnostic parameters-serology, biochemical and histopathology.

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.

Clinical features Common features are-

Fatigue

Loss of appetite

Mild jaundice

Raised serum transaminases

Lab findings reveal liver cell injury

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.

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.

3. BRIDGING FIBROSIS:

Initially portal tract and later periportal areas exhibit fibrosis followed by linking fibrous septa between lobules causing disarray of the architecture.

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

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.

IV. CARRIER STATE Individual with out symptoms but harboring infection with

hepatotrophic virus and is capable of transmittinginfection 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 theworld.

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 asevidenced by HBsAg.

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.