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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Chronic viral hepatitis


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 11 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● Difficult to diagnosis from biopsies with less than 4 identifiable portal tracts
● Biopsy performed to confirm diagnosis and assess inflammatory grade and fibrotic stage of disease
● Diagnosis requires symptomatic, serologic or biochemical evidence of continuing or relapsing hepatic disease of 6 months or more, with histologically documented necrosis and inflammation
● Etiology (hepatitis C > hepatitis B) is the most important predictive factor for chronic hepatitis; clinical features are not predictive
● Terms chronic active hepatitis and chronic persistent hepatitis, based on presence (“active”) or absence (“persistent”) of piecemeal necrosis, are no longer used
Symptoms: spider angiomas, palmar erythema, mild hepatosplenomegaly, hepatic tenderness, increased prothrombin time and partial thromboplastin time, vasculitis due to immune complex deposition (HBV, HCV), glomerulonephritis, cryoglobulinemia (35% of HCV)

Micro description
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● Predominantly lymphocytic portal infiltrate with less lobular involvement than acute hepatitis
● May have piecemeal necrosis and fibrosis

Differential diagnosis (non-viral causes)
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● Wilson’s disease, alpha-1-antitrypsin deficiency, alcoholism, drug reaction (isoniazid, methyldopa, methotrexate), autoimmune hepatitis, sclerosing cholangitis, resolving acute hepatitis

Additional references
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Dig Liver Dis 2011;43:S331-43

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


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