CHRONIC HEPATITIS

Hepatic inflammation and necrosis continue for at least 6 months

Classification: cause, grade, stage

By Cause

Hepatitis B

Hepatitis B and D

Hepatitis C

Autoimmune Hepatitis

Drug-associated chronic hepatitis

Cryptogenic hepatitis

By Grade

Piecemeal necrosis – periportal necrosis and disruption of the limiting plate

Bridging necrosis –confluent necrosis that forms bridges between portal tracts and central vein

Degree of hepatocyte degeneration

Portal inflammation

Scoring Indices: HAI, METAVIR

Table 300-2

Table 300-2

Chronic Viral Hepatitis

Hepatitis A and E – no chronic forms

Hepatitis B

Hepatitis C

Hepatitis B with superimposed Hepatitis D

Chronic Hepatitis B

Likelihood of chronicity varies with age

Infection at birth: clinically silent but 90% chance of chronic infection

In adults: acute infection associated with clinical symptoms but risk of chronicity is 1%

Liver injury: absent (carriers), mild , moderate, severe

Survival Rates

5 Years

Mild 97%

Moderate-severe 86%

Cirrhosis 55%

15 Years

Mild 77%

Moderate-severe 66%

Cirrhosis 40%

CHB: Clinical features

Broad: asymptomatic debilitating end stage hepatic failure

Fatigue, anorexia

Jaundice (persistent, intermittent)

Ascites, edema

Bleeding varices, encephalopathy, coagulopathy, hypersplenism

CHB: Laboratory Features

Elevated bilirubin levels

Elevated ALT/AST

Alk Phos – marginally elevated

Hypoalbuminemia

Prolongation of Prothrombin time

Lab: hepatitis B markers

HBsAg

Anti HBs

HBeAg: viral replication, infectivity, liver injury

AntiHBe

HBVDNA viral load

Clinical Forms of Hep B

HBeAg + CHB: ALT & HBVDNA elevated

HBeAg – CHB: ALT & HBVDNA elevated (pre-core mutants

Hepatitis B carrier: ALT normal; HBVDNA low or undetectable