Chronic Hepatitis and Carrier States
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Questions and Answers

What is the best determinant of chronicity in hepatitis B virus (HBV) infection?

  • The level of serum transaminases
  • Duration of exposure to the virus
  • The presence of jaundice
  • Age at the time of infection (correct)

    • Which of the following is NOT a characteristic of a 'healthy carrier' of HBV?

  • Presence of HBsAg
  • Lack of significant inflammation in liver biopsy
  • High serum HBV DNA levels (correct)
  • Normal aminotransferases

    • Which virus is identified as the most common cause of chronic viral hepatitis?

  • Hepatitis C virus (HCV) (correct)
  • Hepatitis A virus (HAV)
  • Hepatitis E virus (HEV)
  • Hepatitis B virus (HBV)

    • What is a common symptom of chronic hepatitis?

    <p>Persistent fatigue</p> Signup and view all the answers

    In which age group does the carrier state of HBV infection occur in more than 90% of cases?

    <p>Infants and young children</p> Signup and view all the answers

    Which histologic change is specifically indicative of HBV infection?

    <p>Ground-glass hepatocytes</p> Signup and view all the answers

    What role do 'carriers' of hepatotropic viruses play in public health?

    <p>They serve as reservoirs for infection</p> Signup and view all the answers

    Which of the following is the least common symptom associated with chronic hepatitis?

    <p>Severe abdominal cramps</p> Signup and view all the answers

    In non-endemic areas, what is the approximate percentage of HBV infections acquired by adults that produce a carrier state?

    <p>Less than 1%</p> Signup and view all the answers

    What is the main feature of ballooning degeneration in hepatocyte injury?

    <p>Swelling with empty cytoplasm</p> Signup and view all the answers

    What is indicated by the presence of Councilman bodies in a liver biopsy?

    <p>Apoptosis of hepatocytes</p> Signup and view all the answers

    Which cell types are typically found in the inflammation of mild chronic hepatitis?

    <p>Lymphocytes, macrophages, and occasional plasma cells</p> Signup and view all the answers

    What characterizes the histological features of chronic hepatitis?

    <p>Ranging from mild inflammation to severe liver damage</p> Signup and view all the answers

    What is the hallmark of chronic liver damage in the context of hepatitis?

    <p>Deposition of fibrous tissue</p> Signup and view all the answers

    What does continued interface hepatitis and bridging necrosis indicate?

    <p>Progressive liver damage</p> Signup and view all the answers

    In chronic hepatitis due to HCV, which finding is commonly observed?

    <p>Lymphoid aggregates and mild to moderate fatty changes</p> Signup and view all the answers

    What is the sequence of fibrous tissue deposition during chronic liver damage?

    <p>Initial portal tract fibrosis, followed by periportal and bridging fibrosis</p> Signup and view all the answers

    What signifies focal loss of hepatocytes in liver damage?

    <p>Cell membrane rupture leading to cell death</p> Signup and view all the answers

    Which type of cells primarily mark sites of hepatocyte loss?

    <p>Scavenger macrophages</p> Signup and view all the answers

    Study Notes

    Chronic Hepatitis

    • Defined as symptomatic, biochemical, or serologic evidence of continuing or relapsing hepatic disease for more than 6 months.
    • Clinical features vary greatly. Some patients only show persistent elevations of serum transaminases.
    • Common symptom is fatigue; less common are malaise, loss of appetite, and mild jaundice.
    • Age at infection is the most important factor for chronicity; younger ages have higher risk.
    • HCV is the most common cause of chronic viral hepatitis. Often patients exhibit few or no symptoms.

    Carrier State

    • A carrier is someone who carries a virus but may or may not have liver disease. They can be a reservoir for infection.
    • A "healthy carrier" (HBV) carries HBsAg continuously, lacks HBeAg but has anti-HBe, normal aminotransferases, low or undetectable HBV DNA, and a biopsy showing no significant inflammation/necrosis.
    • In non-endemic areas, less than 1% of adult HBV infections result in a carrier state.
    • In endemic areas, HBV infection in early life leads to a carrier state in over 90% of cases.

    Morphology of Acute and Chronic Hepatitis

    • Acute and chronic viral hepatitis (types A-E) share similar morphological changes.
    • HBV-infected cells may show HBsAg spheres/tubules, causing "ground-glass hepatocytes" (pale, finely granular cytoplasm).
    • HCV-infected livers often have lymphoid aggregates in portal tracts and focal lobular macrovesicular steatosis (fatty change).
    • Acute hepatitis involves diffuse swelling (ballooning degeneration) of hepatocytes, with scattered eosinophilic remnants.
    • Cell death can occur by rupture of the cell membrane, or via apoptosis (shrinking, intensely eosinophilic cells with fragmented nuclei – Councilman bodies).

    Chronic Hepatitis Histological Features

    • Chronic hepatitis ranges from mild to severe.
    • Mild cases show inflammation limited to portal tracts, with lymphocytes, macrophages, occasional plasma cells, and rare neutrophils/eosinophils.
    • Chronic HCV often displays lymphoid aggregates and mild-moderate fatty change.
    • All forms of chronic hepatitis, interface hepatitis, and bridging necrosis between portal tracts are signs of progressive liver damage.
    • Fibrosis (scar tissue) is a key feature of chronic liver damage, first appearing in portal tracts, then spreading periportally and bridging different areas.
    • Continued loss of hepatocytes and fibrosis ultimately results in cirrhosis.

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    Description

    Explore the key concepts of chronic hepatitis and the carrier state associated with viral hepatitis infections. This quiz covers symptoms, risk factors, and the differences between healthy carriers and symptomatic patients. Test your understanding of hepatitis C and B in relation to liver disease.

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