Liver and intrahepatic bile ducts - nontumor
Hepatitis (acute and chronic)
Chronic hepatitis - general

Topic Completed: 1 January 2015

Revised: 30 May 2019

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

PubMed Search: Chronic hepatitis[TI] general[TI]

Rifat Mannan, M.D.
Page views in 2018: 8,417
Page views in 2019 to date: 5,413
Cite this page: Mannan A.A.S.R. Chronic hepatitis - general. website. Accessed June 20th, 2019.
Definition / general
  • Liver disease with persistent necroinflammatory activity lasting longer than 6 months
  • Associated with progressive fibrosis that ultimately leads to liver cirrhosis
  • Morphologically characterized by portal inflammation, interface hepatitis, parenchymal inflammation, necrosis and fibrosis (in many cases)
Clinical features
  • Patients have a wide spectrum of clinical manifestations, from asymptomatic to symptomatic decompensated cirrhosis
  • Many patients are asymptomatic or have mild nonspecific complaints such as fatigue
  • Physical findings are typically few; may include hepatomegaly or other stigmata of chronic liver disease, such as palmar erythema
  • Patients with advanced cirrhosis may develop ascites or esophageal varices
  • Serum enzyme levels usually fluctuate but may be elevated 2x to 10x
  • Many patients with mild chronic hepatitis C have persistently normal serum aminotransferase levels
  • Alkaline phosphatase and bilirubin levels are usually normal, except in stages of hepatic decompensation
Microscopic (histologic) description
  • Regardless of etiology, chronic hepatitis is characterized by these features, to variable degrees:
    • Portal inflammation
    • Interface hepatitis
    • Parenchymal inflammation and necrosis
    • Cirrhosis (in many cases)
  • Portal inflammation:
    • Hallmark of chronic hepatitis, ranges from mild and patchy to prominent and diffuse
    • Lymphocytes are the predominant component, often with variable plasma cells
    • Minor component is scattered macrophages, neutrophils and eosinophils
    • Lymphoid follicles may be present, particularly in hepatitis C infection
  • Interface hepatitis:
    • Also known as piecemeal necrosis
    • Important feature of chronic viral hepatitis characterized by:
      • Mononuclear inflammatory infiltrate involving hepatocytes located at (and disrupting) the limiting plate
      • Injury or necrosis of periportal hepatocytes
  • Lobular necroinflammatory activity:
    • Hepatocyte necrosis is usually variable in severity and spotty in distribution
    • Apoptotic hepatocytes (acidophil bodies) are usually more centered on periportal areas and mononuclear cells tend to cluster around dying hepatocytes
  • Fibrosis:
    • Progressive fibrosis of limiting plate leads to enlargement of portal tracts and stellate periportal fibrous extension
    • May lead to portal - portal or portal - central fibrous bridging, culminating in cirrhosis, which is usually micronodular or mixed micronodular and macronodular type
Microscopic (histologic) images

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Portal inflammation in chronic hepatitis

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Interface hepatitis

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Piecemeal necrosis in hepatitis B

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Lobular inflammation

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Fibrosis and cirrhosis

Additional references
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