Author:

Keywords:

Acute Disease, Biopsy, Chronic Disease, Hepatitis, Humans, Necrosis, 1103 Clinical Sciences, Gastroenterology & Hepatology, 3202 Clinical sciences

Abstract:

Histologically, acute hepatitis is characterized by lobular and portal alterations. Lobular changes comprise liver cell pleomorphism and necrosis, reaction of macrophages and cholestasis. The extent of liver cell necrosis varies considerably, ranging from single cell necrosis and focal confluent necrosis, over interlobular confluent (bridging) necrosis to multilobular necrosis. Portal changes consist of inflammatory, mainly lymphocytic, infiltration. Chronic hepatitis is mainly characterized by portal and periportal changes, with lobular lesions in the more severe cases. Chronic persistent hepatitis is characterized by portal lymphocytic infiltration. The hallmark of chronic aggressive hepatitis is periportal extension of the inflammatory infiltrate (piecemeal necrosis). More active cases go through repeated episodes of interlobular or multilobular confluent parenchymal necrosis (subacute hepatitis with bridging necrosis). Lesions of the portal bile ducts may occur in more severe cases. It is important to distinguish as far as possible between chronic hepatitis and cirrhosis. Laparoscopy is helpful in establishing the latter diagnosis.