Pathology of Viral Hepatitis

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Nearly all men can stand adversity, but if you
want to test a man's character, give him
power  Abraham Lincoln
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Pathology of Hepatitis
Dr. Venkatesh M. Shashidhar. Associate Professor
of Pathology Fiji School of Medicine
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Normal Liver
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• 1.5 kg, wedge shape
• 4 lobes, Right, left, Caudate, Quadrate.
• Double blood supply
• Hepatic arteries
• Portal Venous blood
• Acini / Portal triad.
• Lobules central. V

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Normal Liver - Infant
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CT Scan Normal Abdomen
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Structure of Liver Lobule
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Normal Liver - Microscopy
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Introduction

• Hepatitis Inflammation of Liver
• Viral, Alcohol, immune, Drugs Toxins
• Biliary obstruction gall stones.
• Acute, Chronic Fulminant - types
• Viral Hepatitis
• Specific Heptitis A, B, C, D, E, other
• Systemic - CMV, EBV, other.

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Pattern of Viral Hepatitis

• Carrier state / Asymptomatic phase
• Acute hepatitis
• Chronic Hepatitis
• Chronic Persistent Hepatitis (CPH)
• Chronic Active Hepatitis (CAH)
• Fulminant hepatitis
• Cirrhosis
• Hepatocellular Carcinoma

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Acute Hepatitis

• Swelling and Apoptosis
• Piecemeal or Bridging, panacinar necrosis
• Inflammation lymphocytes, Macrophages
• Ground glass hepatocytes HBV
• Mild fatty change HCV
• Portal inflammation and Cholestasis

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Chronic Hepatitis

• Persistent Active types. CPH/CAH
• Lymphoid aggregates
• Periportal fibrosis
• Necrosis with fibrosis bridging fibrosis.
• Cirrhosis regenerating nodules.

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Pattern of Liver Damage

• Zonal Toxin/Hypoxia
• Bridging Viral severe
• Interface Immune
• Apoptotic - Viral

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Acute - Hepatitis - Chronic
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Acute viral Hepatitis
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Acute viral Hepatitis
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Acute viral Hepatitis
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Acute viral Hepatitis
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Liver Biopsy viral Hepatitis-C
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Acute viral Hepatitis C
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Liver Biopsy - CAH
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Liver Biopsy CPH
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Fulminant Hepatitis

• Hepatic failure with in 2-3 weeks.
• Reactivation of chronic or acute hepatitis
• Massive necrosis, shrinkage, wrinkled
• Collapsed reticulin network
• Only portal tracts visible
• Little or massive inflammation time
• More than a week regenerative activity
• Complete recovery or - cirrhosis.

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Liver Cirrhosis
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MRI Cirrhosis
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Liver Biopsy Cirrhosis
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Liver Biopsy Cirrhosis
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Liver Biopsy Cirrhosis
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Viral Hepatitis Microbiology
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Alcoholic Liver Injury
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Alcoholic Liver Injury

• Ethyl alcohol Common cause of acute/Chronic
  liver disease
• Alcoholic Liver disease - Patterns
• Fatty change,
• Acute hepatitis (Mallory Hyalin)
• Chronic hepatitis with Portal fibrosis
• Cirrhosis, Chronic Liver failure
• All reversible except cirrhosis stage.

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Alcoholic Liver Injury Pathogenesis

• Diversion of fat metabolism to alcohol fat
  storage.
• Acetaldehyde metabolite hepatotoxic
• Increased peripheral release of fatty acids.
• Alcohol stimulates collagen synthesis
• Inflammation, Portal bridging fibrosis
• Micronodular cirrhosis.

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Alcoholic Liver Damage
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Alcoholic Fatty Liver
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Alcoholic Fatty Liver
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Alcoholic Fatty Liver
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Micronodular cirrhosis
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