Hepatitis

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Hepatitis

• acute parenchymal liver damage
• extent of damage very variable

Clinical Features

Acute

• often asymptomatic
• prodromal
  • illness +/- jaundice
  • rapid recovery
  • lethargy
• Fulminant liver failure

Causes

• Viruses
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
• Alcohol
• Other infections
  • Toxoplasma gondii
  • Leptospira icterohaemorrhagiae
  • Coxiella burnetii (Q fever)
• drug-induced
  • paracetamol
  • halothane
• chemicals / toxins
  • Amanita phalloides mushrooms
  • Aflatoxin
  • Carbon tetrachloride
• reactive
• Other
  • pregnancy
  • Circulatory insufficiency
  • Wilsons Disease

Pathology

Acute

Macroscopic

• swollen, red oedematous liver
• if fatal
  • shrunken
  • wrinkled
  • dark red areas

Microscopic

• hepatocytes
  • degenerative changes
    • swelling
    • vacuolation
    • cytoplasmic granularity
• necrosis
  • spotty / confluent / panacinar (indicates acute liver failure)
  • shrunken
  • eosinophilic
  • Councilman bodies
  • usually maximal in zone 3
• cellular infiltrate in lobular + portal areas
  • lymphocytes
  • plasma cells
• structural
  • bridging between central veins
  • bridging between central veins and portal tracts
  • bridging between portal tracts

Chronic

• chronic inflammatory infiltrates
  • lymphocytes predominate
  • may form follicles
• expanded portal tracts
• interface hepatitis / piecemeal necrosis

Investigations

• Liver-function tests
• Liver biopsy

Management

• dependent on aetiology

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