Liver and intrahepatic bile ducts - nontumor
Viral hepatitis
Acute viral hepatitis

Topic Completed: 1 May 2012

Revised: 23 January 2019, last major update May 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Acute viral hepatitis[TI] liver[TI]

Komal Arora, M.D.
Page views in 2019: 801
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Cite this page: Arora K. Acute viral hepatitis. website. Accessed March 31st, 2020.
Definition / general
  • Phases: incubation, symptomatic preicteric, symptomatic icteric, convalescence
  • Peak infectivity is at end of incubation period and early symptomatic period
  • Preicteric phase: constitutional symptoms, malaise, fatigue, loss of appetite; serum sickness-like syndrome in 10% (fever, rash, arthralgias due to circulating immune complexes), enlarged and tender liver, elevated serum aminotransferases
  • Icteric phase: may have abatement of severe symptoms (high fever, shaking chills, headache, right upper quadrant pain), jaundice due to conjugated hyperbilirubinemia (dark urine, light stools, pruritis), increased prothrombin time
  • Icteric phase common in acute phase of hepatitis A, 50% of hepatitis B, unusual in hepatitis C
Microscopic (histologic) description
  • Irregular hepatic plates due to variability in hepatocyte size and inflammatory cells
  • Hepatocyte necrosis, portal and lobular lymphocytic inflammation and regenerative activity
  • Hepatocyte death via apoptosis, acidophilic (Councilman-like) body formation, ballooning degeneration or cytolysis (collapse of reticulin network where cells have disappeared with appearance of lymphocytes or macrophages)
  • Infiltrate is usually lymphocytes, most prominent in lobules, then spills over into periportal hepatocytes (interface hepatitis, more sinusoidal in hepatitis C, CMV, EBV)
  • In resolving phase, portal lymphocytes and plasma cells are present with minimal lobular inflammation
  • Kupffer cells contain hemosiderin and lipofuscin
  • Hepatocytes are present in irregularly thickened plates with occasional rosettes and multinucleation
  • Report: degree of hepatocellular damage, presence of regenerative activity, describe inflammatory and stromal response
  • Reticulin shows lobular disarray and areas of dropout
  • Hepatitis viral stains not useful for identifying virus in acute period because infected hepatocytes are destroyed as soon as they express surface viral antigens; however, may be helpful for acute hepatitis D
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