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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Hepatitis A virus (HAV)


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 12 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● 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, pseudo-glands around bile plugs
● Does not produce chronic disease or carrier state in immunocompetent patients
● Causes 50% of hepatitis cases in US; effective vaccine available

Virology
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● Due to Picornavirus, 27 nm virion with single stranded RNA


Drawing of virion

Laboratory
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● Serum IgM anti-HAV is more reliable than immunostains

Micro description
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● 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

Micro images
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Portal and periportal inflammation with some ballooning degeneration


Lobular inflammation


Confluent necrosis (PAS)


Acidophil bodies and hydropic degeneration


With marked cholestasis

Differential diagnosis
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● Chronic hepatitis with moderate/severe activity (fibrosis present)

Additional references
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Liver 1982;2:53, Am J Clin Pathol 1984;81:162

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


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