55Hepatitis Overview: Acute and Chronic
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Questions and Answers

What type of transmission is associated with Hepatitis A infection?

  • Airborne transmission
  • Vector-borne transmission
  • Parenteral transmission
  • Faecal-oral transmission (correct)

    • Which statement is true regarding Hepatitis B and Hepatitis C?

  • Both are primarily transmitted via contaminated food.
  • Both have a high rate of becoming chronic infections. (correct)
  • Hepatitis B commonly leads to silent infections in children.
  • Both are classified as infective hepatitis.

    • What is the histological appearance associated with hepatitis A?

  • Periportal inflammation with plasma cells (correct)
  • Massive necrosis with fibrous tissue
  • Congestion of central veins
  • Lymphoid aggregates predominantly in the portal areas

    • What is a key feature of Hepatitis A regarding chronic infections?

    <p>It has a very rare chronic state. (B)</p> Signup and view all the answers

    Which type of antibody indicates a recent Hepatitis A infection?

    <p>IgM anti-HAV (D)</p> Signup and view all the answers

    What characterizes acute hepatitis?

    <p>Abnormality resolved within 6 months (A)</p> Signup and view all the answers

    Which viruses are primarily associated with acute hepatitis?

    <p>HAV, HBV, HCV, and HEV (B)</p> Signup and view all the answers

    What is a key histological feature of hepatitis regardless of its duration?

    <p>Presence of lymphocytes (B)</p> Signup and view all the answers

    Which of the following can cause chronic hepatitis?

    <p>Hepatitis B virus in certain age groups (B)</p> Signup and view all the answers

    What is the characteristic feature of autoimmune hepatitis?

    <p>May have both acute flares and chronic aspects (B)</p> Signup and view all the answers

    What distinguishes non-alcoholic fatty liver disease from conventional chronic hepatitis?

    <p>It is associated with metabolic syndrome (B)</p> Signup and view all the answers

    Which molecule's presence is significant in HBV serology?

    <p>HBe antigen (A)</p> Signup and view all the answers

    Which of the following is NOT considered under conventional 'chronic hepatitis'?

    <p>Alcohol-related liver disease (B)</p> Signup and view all the answers

    What is a key laboratory finding associated with high AST/ALT levels in children with chronic hepatitis?

    <p>Normal albumin levels (C)</p> Signup and view all the answers

    Which symptom is commonly associated with chronic hepatitis during its presentation?

    <p>Vague symptoms like anorexia/malaise (C)</p> Signup and view all the answers

    What is one of the rare causes of chronic hepatitis mentioned?

    <p>Alpha-1-antitrypsin deficiency (C)</p> Signup and view all the answers

    In assessing chronic hepatitis, what is a non-invasive method used to evaluate fibrosis?

    <p>FibroScan (B)</p> Signup and view all the answers

    Which of the following is NOT categorized as chronic hepatitis?

    <p>Primary biliary cholangitis (PBC) (A)</p> Signup and view all the answers

    What is the primary aim in the management of chronic hepatitis?

    <p>Reduce risk of progression to cirrhosis and hepatocellular carcinoma (HCC) (B)</p> Signup and view all the answers

    What is typically preserved in chronic hepatitis despite the presence of elevated liver enzymes?

    <p>Albumin levels (D)</p> Signup and view all the answers

    What type of inflammation is characteristic of chronic hepatitis?

    <p>Piecemeal necrosis/interface inflammation (A)</p> Signup and view all the answers

    What is the primary risk factor for higher severity of Hepatitis E infection?

    <p>Pregnant women (A)</p> Signup and view all the answers

    Which hepatitis virus requires the presence of Hepatitis B virus for its replication?

    <p>Hepatitis D (C)</p> Signup and view all the answers

    What is the primary cause of chronic hepatitis, cirrhosis, and liver cancer worldwide?

    <p>Hepatitis B (B)</p> Signup and view all the answers

    Which group has a childhood infection rate of 20-30% for chronic Hepatitis B?

    <p>Children (A)</p> Signup and view all the answers

    What method confirms ongoing Hepatitis C infection?

    <p>HCV RNA in blood (B)</p> Signup and view all the answers

    Which of the following is NOT associated with chronic Hepatitis C infection?

    <p>100% chance of resolution (C)</p> Signup and view all the answers

    What is the approximate number of deaths annually attributed to chronic Hepatitis B?

    <p>1 million (A)</p> Signup and view all the answers

    What is the commonest cause of acute liver failure (ALF) in South Asia?

    <p>Hepatitis E (B)</p> Signup and view all the answers

    What is the most common genotype of Hepatitis C found in the US?

    <p>Type 1a (A)</p> Signup and view all the answers

    Which factor does NOT contribute to the risk of progression in chronic Hepatitis C?

    <p>Exercise frequency (A)</p> Signup and view all the answers

    What extrahepatic manifestation is associated with Hepatitis C?

    <p>Diabetes (B)</p> Signup and view all the answers

    What does sustained virological response (SVR) reduce the risk of in chronic Hepatitis C?

    <p>Cirrhosis (A)</p> Signup and view all the answers

    Which histological feature is typically seen in mild chronic hepatitis?

    <p>Portal tract lymphoid aggregates (D)</p> Signup and view all the answers

    Which of the following statements about the histology of mild chronic hepatitis is incorrect?

    <p>Fatty change is not associated with mild chronic hepatitis. (A)</p> Signup and view all the answers

    What is the primary genotype of Hepatitis C found in Europe?

    <p>Type 1b (C)</p> Signup and view all the answers

    Which factor is least likely to worsen the risk of progression in chronic Hepatitis C?

    <p>Regular exercise (B)</p> Signup and view all the answers

    Which of the following extrahepatic manifestations is most closely associated with Hepatitis C?

    <p>Porphyria cutanea tarda (PCT) (A)</p> Signup and view all the answers

    What outcome does a sustained virological response (SVR) NOT reduce the risk of?

    <p>Development of diabetes (B)</p> Signup and view all the answers

    Which of the following statements about acute viral hepatitis is false?

    <p>Confluent necrosis is absent in necrotic areas. (A)</p> Signup and view all the answers

    Which of the following features is NOT commonly associated with Hepatitis A?

    <p>Chronic disease has a significant prevalence. (C)</p> Signup and view all the answers

    What type of transmission is primarily associated with Hepatitis A and Hepatitis E?

    <p>Faecal-oral transmission (A)</p> Signup and view all the answers

    Which of the following statements correctly describes the immune response to Hepatitis A infection?

    <p>IgG anti-HAV indicates previous exposure to the virus. (C)</p> Signup and view all the answers

    Which pathological feature is indicative of acute hepatitis?

    <p>Periportal inflammation with plasma cells (C)</p> Signup and view all the answers

    What is a significant biochemical marker for chronic hepatitis?

    <p>Persistently high AST/ALT (A)</p> Signup and view all the answers

    Which condition is NOT classified under chronic hepatitis?

    <p>Cirrhosis related to alcohol (D)</p> Signup and view all the answers

    Which of the following is characteristic of the interface inflammation seen in chronic hepatitis?

    <p>Blurring of the boundary with liver parenchyma (D)</p> Signup and view all the answers

    What is a common symptom encountered during the presentation of chronic hepatitis?

    <p>Jaundice without abdominal pain (A)</p> Signup and view all the answers

    What is the role of scoring systems in the assessment of chronic hepatitis?

    <p>Guide prognosis and treatment decisions (C)</p> Signup and view all the answers

    In assessing chronic hepatitis, which method is utilized to evaluate the extent of fibrosis non-invasively?

    <p>FibroScan (C)</p> Signup and view all the answers

    What distinguishes autoimmune hepatitis from other causes of chronic hepatitis?

    <p>It has a distinct autoimmune pathogenesis. (C)</p> Signup and view all the answers

    What does the chronicity of hepatitis denote?

    <p>Persisting abnormality beyond 6 months (A)</p> Signup and view all the answers

    Which of the following is most likely to cause acute liver failure?

    <p>Severe acute hepatitis from HAV. (B)</p> Signup and view all the answers

    What factor does NOT contribute to the risk of fibrosis progression in chronic hepatitis?

    <p>Increase in physical activity (B)</p> Signup and view all the answers

    What is a possible outcome of chronic HBV infection depending on the age of the patient?

    <p>Can progress to chronicity in a higher proportion of infected individuals. (A)</p> Signup and view all the answers

    Which symptom is least likely to be associated with acute hepatitis?

    <p>Severe weight gain. (A)</p> Signup and view all the answers

    What type of cell is primarily involved in the inflammatory response in hepatitis?

    <p>Lymphocytes. (A)</p> Signup and view all the answers

    Which condition is categorized distinctly from conventional chronic hepatitis?

    <p>Non-alcoholic fatty liver disease. (B)</p> Signup and view all the answers

    Which characteristic is most associated with viruses that cause acute hepatitis?

    <p>They include both hepatotropic and non-hepatotropic viruses. (A)</p> Signup and view all the answers

    What significant aspect of HBV serology is indicated by the presence of HBe antigen?

    <p>It indicates high levels of viral replication. (D)</p> Signup and view all the answers

    What is the population at the highest risk of serious disease due to Hepatitis E?

    <p>Pregnant women (B)</p> Signup and view all the answers

    Which hepatitis virus is known as a 'passenger' RNA virus that requires HBV for replication?

    <p>Hepatitis D (A)</p> Signup and view all the answers

    What is the approximate global prevalence of chronic Hepatitis B virus infection?

    <p>300 million (B)</p> Signup and view all the answers

    Which group is considered to have the highest prevalence of chronic Hepatitis B, above 8%?

    <p>Southeast Asia (A)</p> Signup and view all the answers

    What is the typical progression rate from acute to chronic infection in Hepatitis C cases?

    <p>80-90% (A)</p> Signup and view all the answers

    What factors influence the risk of chronic disease progression associated with Hepatitis B infection?

    <p>All of the above (D)</p> Signup and view all the answers

    Which Serological test confirms ongoing Hepatitis C infection?

    <p>HCV RNA in blood (A)</p> Signup and view all the answers

    Which hepatitis virus becomes a common cause of acute liver failure in South Asia?

    <p>Hepatitis E (B)</p> Signup and view all the answers

    What factor is considered a significant predictor of response in type 1 Hepatitis C infection?

    <p>Polymorphism in IFNL3/IL28B gene (C)</p> Signup and view all the answers

    Which extrahepatic manifestation is commonly associated with Hepatitis C?

    <p>Cryoglobulinaemia plus glomerulonephritis (B)</p> Signup and view all the answers

    What is the typical estimate of cirrhosis development over two decades in chronic Hepatitis C?

    <p>20% (C)</p> Signup and view all the answers

    Which of the following is NOT typically considered when assessing the clinical course of chronic Hepatitis C?

    <p>Previous viral loads (D)</p> Signup and view all the answers

    What aspect of chronic Hepatitis C increases the risk of progression to cirrhosis?

    <p>Alcohol consumption (D)</p> Signup and view all the answers

    Which of the following accurately describes the connection between faecal-oral transmission and the types of viral hepatitis involved?

    <p>Both Hepatitis A and Hepatitis E can be transmitted through contaminated water. (D)</p> Signup and view all the answers

    Which statement best describes the chronic nature of Hepatitis A and Hepatitis E?

    <p>Neither Hepatitis A nor E results in a chronic infection. (B)</p> Signup and view all the answers

    What is a distinguishing feature of acute viral hepatitis regarding necrosis?

    <p>Spotty focal necrosis can occur individually in hepatocytes. (A)</p> Signup and view all the answers

    Which histological feature is unique to Hepatitis A compared to other types?

    <p>Presence of acidophil bodies. (D)</p> Signup and view all the answers

    Which immune response is triggered by a recent Hepatitis A infection?

    <p>Production of IgM anti-HAV. (C)</p> Signup and view all the answers

    What is the typical outcome of acute hepatitis within six months?

    <p>Complete resolution of abnormality (B)</p> Signup and view all the answers

    Which factor is most likely to contribute to the transition of acute hepatitis to chronic hepatitis?

    <p>Age at infection (A)</p> Signup and view all the answers

    Which type of hepatitis is known to cause only chronic infections?

    <p>Hepatitis B (C)</p> Signup and view all the answers

    Inflammatory cells found in typical cases of hepatitis are primarily comprised of what type?

    <p>Lymphocytes (D)</p> Signup and view all the answers

    Which virus is least likely to be associated with acute diffuse liver damage?

    <p>Hepatitis G virus (HGV) (B)</p> Signup and view all the answers

    What condition is an established cause of chronic liver disease but is not categorized under conventional chronic hepatitis?

    <p>Chronic inflammatory biliary tract diseases (D)</p> Signup and view all the answers

    Which of the following symptoms is most commonly presented with acute hepatitis?

    <p>Nausea and malaise (D)</p> Signup and view all the answers

    What is the significance of recognizing flares of chronic hepatitis in clinical practice?

    <p>May mimic acute hepatitis episodes (B)</p> Signup and view all the answers

    What is a typical laboratory finding associated with chronic hepatitis in children?

    <p>Elevated bilirubin with normal albumin (A)</p> Signup and view all the answers

    Which of the following conditions is considered to have always chronic characteristics?

    <p>Auto-immune hepatitis (D)</p> Signup and view all the answers

    What is the significance of scoring systems in the assessment of chronic hepatitis?

    <p>They guide treatment options and prognosis. (C)</p> Signup and view all the answers

    Which feature distinguishes chronic hepatitis from acute hepatitis?

    <p>Duration of symptoms lasting over six months (A)</p> Signup and view all the answers

    In chronic hepatitis assessment, what does a FibroScan evaluate?

    <p>Fibrosis stage of the liver (C)</p> Signup and view all the answers

    Which of the following conditions shares a risk of fibrosis and progression to cirrhosis but is not categorized as chronic hepatitis?

    <p>Alcohol-related liver disease (B)</p> Signup and view all the answers

    What is an example of a symptom that can present alongside chronic hepatitis?

    <p>Vague symptoms like malaise (A)</p> Signup and view all the answers

    Which biochemical change is a common indicator of prolonged liver injury in chronic hepatitis?

    <p>Persistently high ALT/AST levels (B)</p> Signup and view all the answers

    Which population is at higher risk for severe disease related to Hepatitis E infection?

    <p>Pregnant women (A)</p> Signup and view all the answers

    What is the implication of a positive Anti-HCV antibody test?

    <p>Indicates past exposure but not necessarily current infection (A)</p> Signup and view all the answers

    What is the estimated global prevalence of chronic Hepatitis B infection?

    <p>300 million (C)</p> Signup and view all the answers

    Which situation is least likely to present with acute liver failure due to Hepatitis A?

    <p>Routine vaccinations received before age 1 (B)</p> Signup and view all the answers

    In which demographic is the transmission of Hepatitis D most commonly observed?

    <p>Injecting drug users (B)</p> Signup and view all the answers

    What is a characteristic feature of Hepatitis C infection?

    <p>It shows high mutation rates causing different genotypes (B)</p> Signup and view all the answers

    Which statement reflects the relationship between hepatitis B and hepatitis D infection?

    <p>Hepatitis D only occurs as a superinfection of chronic Hepatitis B (B)</p> Signup and view all the answers

    What is the role of serological tests for Hepatitis E in non-endemic countries?

    <p>To identify zoonotic sources of outbreaks (A)</p> Signup and view all the answers

    Study Notes

    Hepatitis

    • Acute Hepatitis: Liver abnormality resolves within 6 months.
    • Some diseases cause only acute hepatitis (HAV).
    • Some causes of acute hepatitis may become chronic (HBV, HCV).
    • Severe acute hepatitis may cause acute liver failure.
    • Lymphocytes are the inflammatory cells in prototypical cases of hepatitis.
    • Flares of chronic hepatitis may mimic acute hepatitis.

    Chronic Hepatitis

    • Persisting abnormality >6 months
    • Represents ongoing effects of acute hepatitis.
    • Biochemical, histological, or clinical evidence of hepatocellular damage.
    • Various causes but shared histology.
    • Can be detected during routine testing or investigation of symptoms.
    • Cirrhosis and decompensation can occur later.

    Causes of Acute Hepatitis

    • Viruses (HAV, HBV, HCV, HEV, EBV, CMV, rubella)
    • Drugs
    • Symptoms: Nausea, anorexia, malaise.
    • Signs: Enlarged tender liver, jaundice, no signs of chronic disease.
    • Blood: High AST/ALT, elevated bilirubin, normal albumin, lengthened PT.

    Causes of Chronic Hepatitis

    • Chronic viral hepatitis (B, C, B+D)
    • Chronic drug hepatitis (rare)
    • Autoimmune hepatitis (always chronic)
    • Wilson's disease (very rare, always chronic)
    • Alpha-1-antitrypsin deficiency (very rare)
    • Other causes of chronic liver disease/damage (e.g., PBC/PSC, alcohol-related liver disease, NAFLD, haemochromatosis)
    • All these can cause increased risk of fibrosis, cirrhosis, and HCC.

    Assessment of Chronic Hepatitis

    • Blood tests (ALT/AST)
    • Viral load/genotype testing
    • Biopsy: ‘Grade’ of necroinflammatory activity & ‘Stage’ of fibrosis.
    • Non-invasive assessments of fibrosis (e.g., FibroScan)
    • Treatment goals include eliminating or reducing progression to cirrhosis and HCC.

    Viral Hepatitis

    • Hepatotropic viruses: HAV, HEV, HBV, HCV, Yellow fever virus.
    • Transmission: Fecal-oral (HAV, HEV), Parenteral (HBV, HCV), Monkey-mosquito-man (Yellow fever).
    • Coinfection/superinfection possible (HCV/HBV, HBV/HDV).

    Hepatitis A

    • Fecal-oral transmission
    • Usually subclinical or mild illness
    • Symptomatic in adults (jaundice, fever)
    • Silent infection in childhood
    • Very rare cause of ALF, jaundice can be prolonged
    • No chronic disease/carrier state
    • Anti-HAV antibody provides lifelong immunity.
    • IgM anti-HAV indicates acute infection
    • Active immunisation is available.

    Hepatitis A Histology

    • Periportal inflammation with plasma cells
    • Cholestasis
    • Acidophil bodies, apoptosis, “councilman body”

    Hepatitis E

    • Similar illness/epidemiology to hepatitis A.
    • Mainly developing countries
    • Common cause of ALF in South Asia (genotype 1)
    • Sporadic cases in non-endemic countries (zoonotic, genotype 3)
    • Mostly subclinical/mild, rarely acute liver failure.
    • Higher risk in pregnant women
    • No chronic disease/carrier state, except in immunosuppression
    • Histology resembles Hepatitis A

    Hepatitis B

    • 300 million people worldwide with chronic HBV disease.
    • Leading cause of chronic hepatitis, cirrhosis, and liver cancer worldwide.
    • Up to 1 million deaths annually.
    • Prevalence varies by geography and risk factors.
    • High prevalence in Southeast Asia, China, and Africa.
    • Chronic HBV more common with childhood infection (20-30%).
    • High-risk groups: Pregnant women, immunosuppressed patients, IDUs, MSM.

    Hepatitis D

    • RNA "passenger" virus requiring HBV for replication.
    • Co-infection with HBV or superinfection on a chronic HBV background.
    • Increases risk of chronic disease
    • Typically in IDUs.
    • Rare in Ireland.

    Hepatitis C

    • Major cause of "non-A, non-B hepatitis" prior to HCV identification.
    • Major burden of chronic infection worldwide (estimated 180 million).
    • Prevalence varies widely.
    • 6 genotypes which influence behavior and treatment response.
    • Transmission: Blood, IDUs, sporadic.
    • Pathogenesis uncertain.
    • Acute infection typically silent, seldom recognized.
    • Most cases progress to chronic infection (>80%).
    • Chronic infection often identified incidentally.
    • Symptoms: Fatigue, arthralgia.
    • Extrahepatic manifestations in a small percentage.

    Hepatitis C Histology

    • Mild chronic hepatitis
    • Portal tract lymphoid aggregates and follicles
    • Bile duct infiltration by lymphocytes
    • Fatty change
    • Portal and lobular granulomas
    • Giant cell formation

    Hepatitis C Extrahepatic Manifestations

    • Arteritis
    • Cryoglobulinaemia plus glomerulonephritis
    • Porphyria cutanea tarda (PCT)
    • Higher incidence of diabetes
    • Association with lichen planus, Sicca syndrome, and non-Hodgkin lymphoma

    Diagnosis of Hepatitis C

    • Serology: Anti-HCV antibody indicates exposure but does not provide protection.
    • HCV RNA in blood confirms ongoing infection.
    • Genotype: Type 1a (commonest in US, least responsive to interferon), Type 1b (commonest in Europe).
    • Polymorphism in IFNL3/IL28B gene predicts response to treatment for Type 1.
    • Sustained virological response (SVR) reduces progression and risk of complications.

    Hepatitis C Clinical Course

    • Chronic HCV: Risk of progression varies, may take 20-30 years.
    • Histology indicates damage and predicts risk of progression.
    • Non-invasive assessments of fibrosis (FibroScan) available.
    • Biochemistry and clinical presentation may be normal.
    • Untreated HCV can progress to cirrhosis and HCC.

    Hepatitis Definition

    • Hepatitis is an inflammation of the liver.
    • Acute hepatitis: abnormality resolves within 6 months.
    • Some diseases cause only acute hepatitis (HAV).
    • Other diseases cause only chronic hepatitis (AIH, Wilson’s disease).
    • Some causes of acute hepatitis may become chronic (HBV, HCV, HEV).
    • Severe acute hepatitis may rarely cause acute liver failure.

    Causes of Acute Hepatitis

    • Viral causes, especially hepatotropic viruses (HAV, HBV, HCV, HEV, EBV, CMV, rubella).
    • Drug-induced hepatitis, similar to viral-induced.
    • Symptoms include vague symptoms like nausea, anorexia, and malaise.
    • Rarer cases may cause acute liver failure.
    • Signs include an enlarged, tender liver.
    • Jaundice is usually absent and is often seen in children.

    Causes of Chronic Hepatitis

    • Chronic viral hepatitis (B, C, B + D or unknown).
    • Chronic drug hepatitis (rare).
    • Autoimmune hepatitis (always chronic).
    • Wilson's disease (very rare, always chronic).
    • Alpha-1-antitrypsin deficiency (very rare).

    Assessment of Chronic Hepatitis

    • Blood tests like ALT/AST.
    • Viral load and genotype (e.g., HBV, HCV).
    • Liver biopsy.
    • Non-invasive assessments like FibroScan.

    Hepatitis Classification

    • Infective Hepatitis:
      • Hepatitis A and E.
      • Transmitted via fecal-oral route, no chronic state for HAV, very rare for HEV.
    • Serum Hepatitis:
      • Hepatitis B and C.
      • Transmitted parenterally.
      • Risk of chronic state.
    • Other viral causes of Acute Hepatitis:
      • EBV, CMV, rubella.
    • Coinfection/superinfection:
      • HCV and/or HBV and/or HIV, HBV + HDV.

    Hepatitis A

    • Transmitted through fecal-oral route, via personal/sexual contact, contaminated water/shellfish.
    • Usually subclinical or mild illness, more often symptomatic in adults.
    • Silent infection in childhood is a reservoir of infection.
    • Very rare cause of ALF, jaundice can be prolonged but has no chronic disease/carrier state.

    Hepatitis E

    • Similar to hepatitis A, mainly in developing countries.
    • Commonest cause of ALF in South Asia.
    • Sporadic cases are common in non-endemic countries.
    • No chronic disease/carrier state except in immunocompromised patients.

    Hepatitis B

    • 300 million worldwide have chronic HBV disease.
    • Leading cause of chronic hepatitis, cirrhosis and liver cancer worldwide.
    • Prevalence varies greatly by geography and risk.
    • Higher prevalence in Southeast Asia, China, and Africa.
    • Childhood infection has a 20-30% chance of developing chronic HBV.
    • Adults have a 2% prevalence, but higher in pregnant women, patients for immunosuppression, and high-risk groups.

    Hepatitis C

    • Prior to HCV identification in 1987 it was known as “non-A, non-B hepatitis”.
    • Major cause of chronic infection worldwide (180 million).
    • Transmission through blood, IDUs, and sporadically.
    • Acute infection is mostly silent.
    • Most cases (>80%) progress to chronic infection.
    • Chronic infection is often identified incidentally.
    • Chronic HCV presents with vague symptoms like fatigue and arthralgia.
    • A small percentage develop extrahepatic manifestations.

    Hepatitis D

    • Also known as the Delta agent.
    • Passenger RNA virus requiring the presence of HBV for replication.
    • Either co-infection with HBV or superinfection on a background of existing chronic HBV.
    • Increases risk of chronic disease in HBV patients.
    • Typically found in IDUs.
    • Rare in Ireland.

    Hepatitis C Diagnosis

    • Serology: Anti-HCV antibody indicates exposure but most with anti-HCV have active chronic infection.
    • HCV RNA in blood: Confirms ongoing infection.
    • Genotype: Type 1a is most common in the US and least responsive to interferon.
    • Treatment Response: SVR (sustained virological response) reduces progression, risk of cirrhosis and HCC.

    Hepatitis C Clinical Course

    • Risk of progression varies, but usually takes about 20-30 years.
    • 20% chance of cirrhosis over 20 years.
    • Histology and non-invasive assessments like FibroScan help determine risk of progression.

    Piecemeal Necrosis/Interface Inflammation

    • Portal tract is inflamed, blurring the boundary with the liver parenchyma and damage to liver cells.
    • Prototypical pattern of chronic hepatitis, especially HBV and autoimmune hepatitis.

    Acute Viral Hepatitis Pathological Features

    • Spotty focal necrosis of individual hepatocytes.
    • Confluent bridging necrosis, linking vascular structures, typically in zones 1 and 2.
    • Panacinar necrosis is present when zones 1, 2, and 3 show necrosis.

    Hepatitis Definitions

    • Acute hepatitis: Inflammation of the liver resolving within 6 months.
    • Chronic hepatitis: Liver inflammation persisting for over 6 months, evidenced through biochemical, histological, or clinical findings.

    Causes of Hepatitis

    • Acute Hepatitis: Can be caused by viruses (HAV, HBV, HCV, HEV, EBV, CMV, Rubella), drugs, and toxins.
    • Chronic Hepatitis: Can be caused by chronic viral hepatitis (HBV, HCV, HDV), autoimmune hepatitis, Wilson's disease, Alpha-1-antitrypsin deficiency, and chronic drug hepatitis.

    Hepatitis A

    • Transmitted faecal-orally, typically via contaminated water or food.
    • Most commonly encountered in endemic areas.
    • Usually results in a mild illness, but can be severe in adults.
    • Rarely causes acute liver failure.
    • No chronic disease or carrier state.
    • Lifelong immunity is conferred by anti-HAV antibody.
    • IgM anti-HAV signifies recent infection.
    • Vaccination is recommended for those at risk.

    Hepatitis B

    • A major global health concern, causing chronic hepatitis, cirrhosis, and liver cancer.
    • Over 300 million individuals worldwide suffer from chronic HBV infection.
    • Prevalence varies geographically, with higher rates in Southeast Asia, China, and Africa.
    • Transmission occurs through bloodborne routes.
    • Infected mothers can transmit the virus to their newborns.
    • Up to 90% of infected children develop chronic HBV infection.
    • Co-infection with HDV (Delta agent) significantly increases the risk of chronic disease.

    Hepatitis C

    • Identified in 1987, previously referred to as "non-A, non-B hepatitis."
    • A significant cause of chronic liver disease and cirrhosis.
    • A major global health concern due to the high number of individuals infected (~180 million).
    • Prevalence varies, with different genotypes affecting treatment response.
    • Transmission occurs mainly through bloodborne routes, especially in IDUs.
    • Acute infections are often silent and go unrecognized.
    • Most cases rapidly progress to chronic infection.
    • Chronic HCV can be diagnosed incidentally, and may have vague symptoms.

    Hepatitis E

    • Closely resembles hepatitis A in its illness and epidemiology.
    • Prevalent in developing nations, with waterborne outbreaks.
    • Can cause acute liver failure, particularly in South Asia.
    • Rare instances of chronic disease have been reported in immunosuppressed individuals.

    Hepatitis D

    • An RNA virus that requires pre-existing HBV infection for replication.
    • Co-infection or superinfection with HBV increases the risk of chronic HBV infection.
    • Typically observed in IDUs.

    Chronic Hepatitis Assessment

    • Evaluation includes blood tests (ALT/AST), viral load/genotype (for HBV and HCV), and liver biopsy.
    • Treatment aims to eliminate, reduce, or postpone the progression to cirrhosis and reduce the risk of liver cancer.
    • Non-invasive methods like FibroScan are used to assess liver fibrosis.

    Histological Features

    • Acute Viral Hepatitis: Characterized by spotty focal necrosis, bridging necrosis, and panacinar necrosis.
    • Chronic Hepatitis: Marked by periportal inflammation with plasma cells, cholestasis, and the presence of Councilman bodies.

    Hepatitis C Histology

    • Mild Chronic Hepatitis: Involves portal tract lymphoid aggregates, bile duct infiltration by lymphocytes, and fatty changes.
    • Giant cell formation: Can be present in chronic hepatitis C.

    Hepatitis C Extrahepatic Manifestations

    • Can include arteritis, cryoglobulinaemia, porphyria cutanea tarda, diabetes, lichen planus, Sicca syndrome, and non-Hodgkin lymphoma.

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