Viral hepatitis: Pathology review
00:00 / 00:00
Questions
USMLE® Step 1 style questions USMLE
of complete
Memory Anchors and Partner Content
Transcript
At your clinic, 44-year-old Colin comes to the office because of abdominal pain for 3 months.
He has not been to a physician in 10 years and has been using IV drugs since he was 17.
He does not drink alcohol and has no significant family history.
His temperature is 38.2°C or 100.76°F, pulse is 98/min, respirations are 19/min, and blood pressure is 126/84 mmHg.
Physical examination shows a large distended abdomen, yellow sclera, palmar erythema, and spider angioma on his abdomen and extremities.
Lab results reveal the following: Hepatitis A IgM antibody negative, Hepatitis B surface antigen negative, Hepatitis B surface antibody positive, Hepatitis B core antibody negative, and HCV antibody positive.
At the same time, a 32-year-old pregnant individual named Megan comes to the emergency department because of vomiting and fever.
The patient worked as a global health nurse and her medical history is relevant for recent traveling to Nepal.
Physical examination shows yellowing of the skin and sclera, right upper quadrant tenderness, and hepatomegaly.
Her temperature is 38.5°C or 101.3°F, pulse is 97/min, respirations are 15/min, and blood pressure is 120/75 mmHg.
Both Colin and Megan have viral hepatitis, which is inflammation of the liver parenchyma caused by hepatitis viruses A, B, C, D, or E.
Based on the duration of symptoms, hepatitis can be acute, which lasts less than 6 months, or chronic, which lasts more than 6 months.
Individuals with acute viral hepatitis typically present with fatigue, malaise, nausea, vomiting, anorexia, low-grade fever, jaundice, dark urine, and right upper quadrant tenderness; whereas individuals with chronic viral hepatitis can be asymptomatic or they can present with non-specific symptoms such as malaise and fatigue.
Regardless of the virus that’s causing it, histopathology of viral hepatitis is characterized by two main findings: first, there’s hepatocyte injury where the damaged hepatocytes swell up, and this is called ballooning degeneration; second, there’s hepatocyte death and necrosis.
Summary
Viral hepatitis is defined as inflammation of the liver parenchyma and it is most commonly caused by hepatitis viruses A, B, C, D, and E. When a person is infected with a hepatitis virus, the virus targets and infects liver cells, leading to inflammation and damage to the liver tissue. This can result in a range of symptoms, including fatigue, nausea, abdominal pain, jaundice, and in severe cases, liver failure.
In acute viral hepatitis, the immune system responds to the infection by producing antibodies that help to clear the virus from the body. However, in some cases, the virus can persist and lead to chronic hepatitis, which can cause ongoing liver damage and increase the risk of cirrhosis and liver cancer.
The severity and course of the infection can vary depending on the specific virus involved, as well as other factors such as the individual's age, immune status, and underlying health conditions. Treatment options also vary depending on the virus and the severity of the infection and may include antiviral medications, supportive care, and in some cases, liver transplantation.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book" Elsevier Health Sciences (2013)
- "Extrahepatic manifestations of chronic hepatitis C virus infection" Therapeutic Advances in Infectious Disease (2015)
- "Hepatitis C" Human Vaccines & Immunotherapeutics (2013)
- "Hepatitis E" New England Journal of Medicine (2012)
For Institutions
Copyright © 2024 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Cookies are used by this site.
USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.
