Definition and morphological picture
The morphological picture of chronic hepatitis is based on three key components: recurrent inflammation, the presence of persistent tissue necrosis, and the development of fibrosis. The fundamental difference between this pathology and cirrhosis is that in hepatitis, the normal angioarchitecture of the liver is preserved.
The disease is a major global public health problem affecting approximately 300 million people worldwide.
Classification principles
Modern classification of the pathology is based on the etiological principle. A full diagnosis requires assessing the disease along three main vectors: etiology, activity, and stage.
1. By etiology:
- Viral (associated with viruses B, C, D, G, F, TTV, etc.).
- Autoimmune hepatitis (AIH).
- Drug-induced.
- Cryptogenic (of unknown etiology).
2. By degree of activity: The activity of the inflammatory process is usually assessed by the blood level of alanine aminotransferase (ALT).
| Degree of activity | ALT level |
|---|---|
| Minimal | No or minor elevation |
| Low | Less than a 3-fold increase above the normal limit |
| Moderate | 3–10-fold increase above the normal limit |
| High | More than a 10-fold increase above the normal limit |
3. By disease stage: The stage is determined by the severity of fibrotic changes: from the complete absence of fibrosis to mild, moderate, severe fibrosis, and, ultimately, liver cirrhosis (LC).
Features of the course of viral hepatitis
The structure of viral hepatitis incidence shows the following distribution:
- Hepatitis B virus (HBV) dominates, accounting for 40% of cases.
- Hepatitis C virus (HCV) causes 33% of disease cases.
- Hepatitis G virus is found in 6% of patients.
- Mixed infection (combination of HBV and hepatitis D) accounts for 5%.
When confirming a viral etiology, it is critically important to determine the current phase of the infectious process. There are the replication phase (active viral multiplication occurs) and the integration phase (the viral genome is integrated into the hepatocyte DNA).
Clinical presentation and syndromes
The symptoms of chronic hepatitis are not strictly specific. The clinical picture traditionally distinguishes five leading syndromes:
- Asthenic syndrome — manifests as general weakness and increased fatigue.
- Dyspeptic syndrome — includes nausea, vomiting, abdominal bloating (flatulence), and various stool disorders.
- Pain syndrome — characterized by abdominal pain, predominantly localized in the right upper quadrant.
- Cholestasis syndrome — accompanied by yellowing of the skin and mucous membranes, and skin itching. Darkening of the urine and discoloration of feces are characteristic, as well as the appearance of specific formations — xanthelasma and xanthomas.
- Hepatomegaly syndrome — objectively detected enlargement of the liver.
To remember the 5 main clinical syndromes, use the phrase: «Active Doctor Fights Chronic Hepatitis» (Asthenic, Dyspeptic, Fibrosis-related pain, Cholestasis, Hepatomegaly).
Class and exam questions
What is the main morphological difference between chronic hepatitis and liver cirrhosis?
The key difference is that in chronic hepatitis, despite inflammation and the development of fibrosis, the normal angioarchitecture of the liver is preserved.
How is the degree of disease activity assessed?
The degree of activity is assessed by the level of the ALT enzyme. For example, with low activity, the norm is exceeded by less than 3 times, and with high activity, by more than 10 times.
What phases of the infectious process exist in viral hepatitis?
There are two main phases: replication (when the virus actively multiplies) and integration (when the viral genome is integrated into the hepatocyte DNA).
What else to study on this topic
- Pathogenesis and diagnostic features of autoimmune hepatitis (AIH)
- Morphological methods for assessing the degree of liver fibrosis
- Mechanisms of development of drug-induced hepatitis
- Differential diagnosis of jaundice in cholestasis syndrome
- Specifics of mixed infections (HBV + hepatitis D)
Master the entire topic in the Pediatrics course
This is a summary. The course covers everything tested in classes and exams.
- Full study guide on the topic "Chronic Hepatitis" and another 3,738 pages of the subject
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- AI tutor answers questions on the topic anytime
- 71 video lessons on the subject
Other topics in "Chapter 7. Digestive System Diseases"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.