2. Definition
Chronic hepatitis indicates a
persistent, and often
progressive, necroinflammatory
process of the liver lasting more
than 6 months and is
characterized histologically by
lymphocytic infiltration of the
portal tracts together with
varying degrees of parenchymal
inflammation, hepatocellular
injury, and fibrosis.

3. chronic hepatitis has been divided on morphologic
grounds into three groups
chronic active hepatitis
• Chronic hepatitis with piecemeal (periportal) necrosis (or
interface hepatitis) with or without fibrosis.
chronic persistent hepatitis
• chronic hepatitis with no significant periportal necrosis or
regeneration with a fairly dense mononuclear portal
infiltrate
chronic lobular hepatitis
• chronic hepatitis with persistent parenchymal focal
hepatocyte necrosis (apoptosis) with mononuclear
sinusoidal infiltrates.

4. discrimination by differences in prognosis.
uncomplicated portal
inflammation and
pronounced lobular
inflammation respectively,
were considered benign,
nonprogressive lesions
aggressive
hepatocellular necrosis
and fibrosis, was
regarded as a serious,
progressive process
leading to cirrhosis

5. CAUSES
Viruses
Fatty infiltration
inherited metabolic disorders
Alpha 1-antitrypsin deficiency
Alcohol
autoimmune disease
reactions to medications

6. Symptoms
Asymptomatic or have
only minor complaints
The most common
symptoms include
The disease may have an insidious onset
or may present abruptly; occasionally it
follows an episode of acute hepatitis that
fails to remit
others exhibit features of
chronic liver disease or
hepatic failure
fatigue or malaise,
with mild abdominal discomfort,
jaundice,
anorexia, fever, nausea,
or arthralgias

7. Extrahepatic manifestations
amenorrhea,
acne,
gynecomastia,
or Cushinoid changes
Physical examination
findings
hepatomegaly, mild splenomegaly,
and, occasionally, spider angiomas
or palmar erythema
Unfortunately, the clinical findings are not specific and correlate poorly with the severity
of the disease.

8. The characteristic
laboratory
abnormalities
include
increase, usually of two- to 10-fold, in serum
transaminase levels
Other liver tests are generally normal or only
mildly abnormal; increasing serum bilirubin,
falling albumin levels, and a prolonged
prothrombin time signal advanced, progressive
disease
Liver biopsy assessment in chronic
hepatitis
liver biopsy provides the best information
available concerning the amount of hepatic
fibrosis and the amount of ongoing
inflammation and necrosis

9. Inflammation (Grade)
Lobular
Inflammation and
Necrosis
Grade
Description
Piecemeal
Necrosis
0
No activity
None
None
1
Minimal
Minimal, patchy
Minimal;
occasional spotty
necrosis
2
Mild
Mild; involving
Mild; little
some or all portal hepatocellular
tracts
damage
3
Moderate
Moderate;
involving all
portal tracts
4
Severe
Severe; may have Severe, with
bridging fibrosis prominent diffuse
hepatocellular
damage
Moderate; with
noticeable
hepatocellular
damage

10. Degree of fibrosis (Stage)
Stage 0: no fibrosis
Stage 1: enlarged fibrotic portal tracts
Stage 2: periportal fibrosis or portal to portal
septa, without architectural distortion
Stage 3: bridging fibrosis with architectural
distortion, no obvious cirrhosis
Stage 4: cirrhosis (probable or definite)

11. The etiology is established through
Suggestive Histologic
Findings
Liver
Immunohistochemistry
HBsAg, HBeAg, HBV-DNA,
HBcAg in liver
Hepatitis B
Ground-glass cells
Hepatitis C
Fatty change, Sinusoidal
none
inflammation, Lymphoid follicles,
Bile duct damage
Anti-HCV, Clinical history
Hepatitis D
none
HDV antigen
Anti-HDV, HDV-RNA, HDV
antigen in serum or liver
AutoimmuneAssociated
none
none
Autoantibodies,
Serum immunoglobulins
Drug-Induced
none
none
Drug history
Copper accumulation, Fatty
change, Glycogenated nuclei
none
Serum ceruloplasmin,
Quantitative copper studies
Wilson's Disease
Alpha-1-Antitrypsin
Deficiency
HBsAg, HBcAg
Definitive Diagnosis
PAS-positive cytoplasmic globules Alpha-1-antitrypsin
Serum levels and
phenotyping

12. prognosis