Viral Hepatitis

Acute Hepatitis
The various forms of viral hepatitis induced by different viruses have a similar morphology. Macroscopically, there is hepatomegaly with an edematous capsule, and distinct necrotic areas which lead to surface irregularities. In fulminant hepatitis, necrosis results in liver shrinkage and a relevant loss of parenchymal volume, however, there might be complete restitution. If necrosis occurs there may be scar formation, which is morphologically similar to that in cirrhosis. Cirrhosis typically develops in cases of chronic hepatitis.

Chronic Hepatitis
An inflammatory process which lasts longer than six months without signs of regression is referred to as chronic hepatitis.Histologically, chronic hepatitis
is a necro-inflammatory,primarily hepatocytic disease with or without cirrhosis, in which lymphocytes clearly dominate the inflammation.There is a gradation regarding the degree of inflammation, its localization and the subsequent fibrosis.
Macroscopically, an enlarged liver can be demonstrated in the acute phase caused by edematization. Ascites and splenomegaly are signs of a more fulminant course. The main etiological categories for chronic hepatitis in addition to virus infection.

Etiological categories of chronic hepatitis

• Viral (HBV, HDV, HCV)
• Autoimmune (classic lupoid-type and subtypes)
• Autoimmune overlap syndromes
• Drug induced (e.g. nitrofurantoin, α-methyldopa,
isoniazid and others)
• Cryptogenic

Liver Disease in Congestive Heart Disease

Chronic failure of the right heart leads to an enlarged liver via congestion. Diffuse cell necrosis may develop due to the decreased blood flow, increased blood pressure and resulting hypoxemia.

image

Macroscopic aspect of cardiac liver cirrhosis based on
congestive heart disease, leading to increased intrahepatic blood
pressure and reduced flow with subsequent cirrhosis

Cell necrosis thereafter induces a fibrosis which resembles micronodular cirrhosis.However, in contrast to other forms of cirrhosis, the microscopic
architecture remains intact.

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