Liver and intrahepatic bile ducts - nontumor
Viral hepatitis
Hepatitis A virus (HAV)

Topic Completed: 1 May 2012

Revised: 23 January 2019, last major update May 2012

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

PubMed Search: Hepatitis A virus[mh] liver[TIAB]

Komal Arora, M.D.
Page views in 2018: 1,107
Page views in 2019 to date: 914
Cite this page: Arora K. Hepatitis A virus (HAV). website. Accessed October 17th, 2019.
Definition / general
  • Fecal - oral transmission via contaminated food or water
  • Associated with overcrowding or poor sanitation
  • Usually children (asymptomatic or symptomatic without jaundice)
  • In adults, infection more severe with malaise and jaundice for 7 - 10 days
  • Rarely causes massive hepatic necrosis and acute liver failure; fatal in < 0.5% of cases
  • May cause acute cholestatic hepatitis with bile ductular proliferation, neutrophils around ducts, cholestasis, hepatocyte ballooning, pseudoglands around bile plugs
  • Does not produce chronic disease or carrier state in immunocompetent patients
  • Causes 50% of hepatitis cases in US; effective vaccine available
  • Due to picornavirus, 27 nm virion with single stranded RNA
Diagrams / tables

Images hosted on other servers:

Drawing of virion

  • Serum IgM anti-HAV is more reliable than immunostains
Microscopic (histologic) description
  • Periportal inflammation and necrosis, ballooning degeneration, apoptosis
  • Cholestasis and increased portal and periportal plasma cells are relatively specific for hepatitis A
  • Acidophil bodies or cytolysis are present (collapse of reticulin network where cells have disappeared with appearance of macrophage aggregates)
  • Bridging necrosis if severe hepatitis
  • Also interface hepatitis (inflammatory infiltrate spills over into adjacent parenchyma to cause necrosis of periportal hepatocytes)
  • Relative sparing of centrilobular hepatocytes
Microscopic (histologic) images

Images hosted on other servers:

Portal and periportal
inflammation with
some ballooning

Lobular inflammation

Confluent necrosis (PAS)

Acidophil bodies and hydropic degeneration

With marked cholestasis

Differential diagnosis
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