Page 444 - Concise Pathology for Exam Preparation ( PDFDrive )

15 Diseases of the Hepatobiliary System and Pancreas 429

Acute Viral Hepatitis

Acute viral hepatitis is further subdivided into the following clinical stages:
1. Incubation period.
2. Symptomatic preicteric phase: Also called prodromal phase, it lasts for a few days up to
2 weeks before the onset of jaundice, and manifests with fever, headache, malaise, an-
orexia, nausea, vomiting, diarrhoea, distaste for cigarettes and upper abdominal pain
(due to stretching of liver capsule). Patients with HBV infection occasionally have a
‘serum sickness-like syndrome’ with skin rashes and polyarthralgia.
3. Symptomatic icteric phase: This is characterized by conjugated hyperbilirubinaemia with
passage of dark urine and yellowish discolouration of the sclera. The constitutional symp-
toms diminish with the onset of clinical jaundice when the patient develops tender
hepatomegaly. With progressively increasing obstruction to biliary canaliculi, jaundice
worsens, stools become paler, urine becomes darker and liver becomes more palpable
(cholestatic phase). Icteric phase is seen in HAV infection, but is rare in HBV and HCV
infections.
4. Convalescence or recovery phase: There is improvement in the gastrointestinal symp-
toms; decrease in jaundice, normalization of stools and urine and decrease in the liver
size. The clinical and biochemical recovery should be complete in 1–2 months from
the onset in cases of hepatitis A and E and in 3–4 months from the onset in hepatitis
B and C.
Points to Remember
Delta coinfection is indistinguishable from acute hepatitis B, but delta super infection
appears like an acute episode in a person chronically infected with HBV.
Hepatitis B, D and E can result in fulminant hepatic failure. It is uncommon with hepatitis
A and C. Pregnant women suffering from hepatitis E have a high incidence of fulminant
hepatitis (20%).
Anicteric hepatitis is a mild illness with an anicteric course (no clinical jaundice).

Morphological Features (Fig. 15.3)
• Hepatocyte injury and ballooning degeneration (swelling of hepatocytes with empty
looking cytoplasm due to clumping of the cytoplasm around the nucleus)
• Cholestasis (seen as canalicular bile plugs)

Inflammatory infiltrate Portal tract Ballooning degeneration

Councilman body Regenerating Dropout necrosis
(acidophil body) hepatocyte Central vein
FIGURE 15.3. Section from acute viral hepatitis showing hepatocyte necrosis and periportal
inflammation.

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