Hepatitis Pathology

Patholosgy of Hepatiti

1. Hepatitis Department Of Pathology Dr. Anurag Yadav BHMS, MD ( Hom ) Assistant Professor

2. Hepatitis Hepatitis is a broad term that refers to inflammation of the liver, characterized by presence of inflammatory cells, irrespective of the underlying cause.  Hepatitis is caused by a number of conditions, including drug toxicity, immune diseases, and viruses.

3. Viral Hepatitis Alcoholic Hepatitis Autoimmune Hepatitis Non- alcoholoic steato -hepatitis (NASH) Etiology Of Hepatitis

4. Etiological Factors

5. Types Of Hepatitis Most cases of  acute hepatitis resolve spontaneously, but some progress to chronic hepatitis.

6. Types Of Hepatitis

7. Clinical features Acute hepatitis- Initial symptoms are mostly nonspecific, such as nausea, body ache, fever, nausea, vomiting, etc. Profound loss of appetite, choluria (dark urine), jaundice and abdominal discomfort / pain are relatively specific symptoms of hepatitis Small proportion of patients present with acute liver failure Chronic hepatitis- May be asymptomatic or with nonspecific symptoms Often detected by laboratory evaluation Extensive damage may lead to features of cirrhosis and portal hypertension

8. Microscopic Changes Acute hepatitis- Characterized by "lobular disarray," which includes- Ballooning degeneration Spotty necrosis Predominantly sinusoidal and lobular mononuclear cell infiltrate Kupffer cell hyperplasia` Apoptotic bodies Canalicular cholestasis Chronic hepatitis- characterized by varying degrees of- Portal inflammation Interface hepatitis Parenchymal inflammation and necrosis Fibrosis / cirrhosis

9. Fulminant Hepatitis Rare and life-threatening complication of acute hepatitis that can occur in cases of hepatitis B, D, and E Besides the signs of acute hepatitis, people can also demonstrate signs of  coaglopathy (abnormal coagulation studies with easy bruising and bleeding) and encephalopathy(confusion, disorientation, and sleepiness) Mortality due to fulminant hepatitis is typically the result of various complications including cerebral edema , gastrointestinal bleeding, sepsis, respiratory failure, or kidney failure.

10. Viral Hepatitis Viral hepatitis, accounts for more than 50% of cases of acute hepatitis. Viral Hepatitis is a systemic disease with inflammation of liver by any one from the group of Hepatotropic viruses . The most common Hepatotropic viruses are-   Hepatitis A virus  (HAV),  Hepatitis B virus  (HBV),   Hepatitis C virus  (HCV) Hepatitis D virus  (HDV) and  Hepatitis E virus  (HEV). Hepatitis F & G viruses are also seen. In addition to these viruses, other viruses that can cause hepatitis includes- Adenovirus , Cytomegalovirus (CMV), Epstein-Barr virus (EBV) and, rarely, Herpes Simplex Virus (HSV).

11. Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Genome RNA DNA RNA RNA RNA Incubation Period 15-45 Days 45-160 Days 15-150 Days 30-50 Days 15-60 Days Route Faeco -oral Parentral , STD Parentral Parentral Faeco -oral Severity Mild Severe Modrate Modrate Mild Chronicity None 10% 50-60% 10% None Hepatocellular Carcinoma No + + + No Features Of Hepatitis Viruses

12. Factors Acute/ Chronic Hepatitis Type Of The Viruses Age Of The Patient Health Of The Patient Status Of Immune System

13. Pathophysiology The virus do not posses hepatotoxic effect & hence do not cause direct Apoptosis (Cell Death), but it is host immune response activated by virus infection leading to inflammatory responsewhich causes cellular damage & Death Natural killer cells are primary response which triggers virus specific cytokine. Chiefly hepatocyte injury is caused by virus specific Cytokine- CD4+ T helpar cell, CD8+ cytotoxic T-cells & Interferon γ which attack infected hepatocytes .

14. Clinical Features Symptoms can be classified into 3 Phases-

15. Prodormal Phase Due to Viremia IL-1, IL-6 & TNF-A leads to Flu like symptoms like- Fever Headache Malaise & Fatigue Nausea & Vomiting Joint & Muscle Pain Diarrhoea

16. Icteric Phase Symptoms appear due to continued Liver damage- Icterus Jaundice Hepatomegaly Pain Rt. Hypochondrium Dark Urine Clay coloured stool AST elevated ALT elevated ALP elevated

17. Icteric Phase Some extra hepatic menifestatiobn is seen in Viral hepatitis especially in Hepatitis B & C- Arthritis Vasculitis (PAN) Pericarditis Myocarditis Glomerulonephritis Thrombocytopenia Neutropenia Hemolytic Anemia

18. Convalescent Phase Recovery Phase, Symptoms become mild & gradually improve:- Liver size return to normal Jaundice decreases Appetite Improves Stool & Urine return to normal color This phase lasts for about 1-2 months for Hepatitis A & E and 3-4 months in case of Hepatitis B & C

19. I nvestigations Hepatitis can be difficult to diagnose because it can be asymptomatic or symptoms may be non-specific . Diagnosis can be done through-

20. Blood Investigations Includes Test For:- Liver Enzymes Elevated AST Elevated ALT Elevated ALP Serology HBsAg , Anti-HBs, HBeAg , HAV- Ab Autoantibodies (ANA) Nucleic Acid Testing (For Virus DNA/RNA) CBC

21. Imaging Includes :- Ultrasonography Specialized X-rays CT MRI To identify fatty change, nodularity of liver surface, helps to determine cause of Liver injury

22. Liver Biopsy It is the most definitive way to diagnose liver damage. It is used primarily when other tests are inconclusive or to determine how much liver damage has occurred. It is an invasive procedure in which a needle is inserted into the liver to withdraw a small amount of tissue that is examined under a microscope by a  pathologist.

23. Prevention Behavioral Changes Practice good personal hygiene & sanitation Drink boiled water Have healthy nutritive diet Avoid unsafe sex Don’t use infected persons personal items Avoid sharing needles etc. Vaccines Vaccines for Hepatitis A and Hepatitis B that are available but not for Hep C & E.