Page 445 - Concise Pathology for Exam Preparation ( PDFDrive )

430 SECTION II Diseases of Organ Systems

• Hepatocyte necrosis (necrosis of isolated cells or clusters) seen as cytolysis (dropout
necrosis) and apoptosis (formation of apoptotic or Councilman bodies)
• Bridging necrosis (confluent necrosis of hepatocytes connecting portal–portal, portal–
central, central–central areas).
• Lobular disarray leading to loss of normal architecture
• Regenerative changes including hepatocyte proliferation and reactive sinusoidal
changes (Kupffer cell hyperplasia and hypertrophy)
• Portal tracts show periportal inflammation (mainly mononuclear) with inflammatory
spillover into adjacent parenchyma and hepatocyte necrosis.
• HCV infection is commonly associated with duct proliferation, lymphoid aggregates in
the portal tracts and mild fatty change.
• HBV-induced changes include development of fine granularity in the cytoplasm of liver
cells or ground glass appearance due to the accumulation of spheres and tubules of
HBsAg and sanded nuclei due to abundant intranuclear HBcAg.

Complications
• Fulminant hepatic failure
• Chronic hepatitis
• Cirrhosis
• Hepatocellular carcinoma
• Hepatocellular failure
• Renal failure
Chronic Hepatitis

It is defined as symptomatic, biochemical or serological evidence of continuing or relaps-
ing hepatic disease for more than 6 months with histologically documented inflammation
and necrosis.
Causes
• Chronic viral hepatitis
• Wilson disease
• a-1 antitrypsin deficiency
• Chronic alcoholism
• Drugs—isoniazid, methyl dopa and methotrexate
• Autoimmune hepatitis
• Cryptogenic chronic hepatitis
Clinical Features
• Persistent elevation of serum aminotransferases
• Fatigue, malaise, loss of appetite and mild jaundice
• Spider angiomas, palmar erythema, mild hepatomegaly and hepatic tenderness
• Prolonged prothrombin time, hypergammaglobulinaemia, hyperbilirubinaemia and mild
increase in alkaline phosphatase
• In HBV and HCV disease, circulating immune complexes may cause vasculitis and
glomerulonephritis

Classification
Old classification of chronic hepatitis
1. Chronic persistent hepatitis (CPH)
(a) Infiltration by chronic inflammatory cells is confined to the portal tracts.
(b) Changes in hepatocytes are absent or slight (‘spotty necrosis’ or small foci of liver
cell necrosis with inflammatory cell infiltration).
(c) Lobular architecture is maintained.
(d) Prognosis is excellent. Rarely, may progress to chronic active hepatitis or cirrhosis.

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