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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Acute viral hepatitis


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 9 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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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

Micro description
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● 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

Stains
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● 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

End of Liver and intrahepatic bile ducts-nontumor > Viral hepatitis > Acute viral hepatitis


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