Lecture 20: Acute & Chronic Hepatitis: Pathology & Pathophysiology

Terms in this set (43)

Diagnosed by HBsAg in blood; ANTI-HBe lasts long term

Phase 1- Immune Tolerant Phase
•Immune system is not good enough & do not see that hepatocytes infected
•Viruses replicating in hepatocytes
•Lots of virus in the blood - high HBV DNA levels
•No inflammation in liver - ALT levels low b/c no response
•Can last decades (from perinatal transmission) or wks to months or even absent (adults who are infected)

Phase 2 - Immune Clearance (active) phase
•Eventually immune system wakes up and kicks in
•Immune system tries to eradicate the infection - inflammation & necrosis on biopsy
•Can lead to fibrosis & cirrhosis
•Greatest risk for progression of liver disease
•Hepatocytes dying and ALT increases
•Less HBV virus so HBV DNA decreases - virus in blood, e antigen as marker of viral replication

Phase 3 - Nonreplicative phase
•Milestone event occurs at some point - immune system gets better, something changes in virus or through meds
•Stop making e antigen, stop making the virus
•Viral DNA levels decrease
•Making antibodies to e antigen
•Immune system stops killing hepatocytes b/c no virus and ALT return to normal
•Liver biopsy - depends upon how much inflammation & scarring in previous stage
•Short phase 2 can look good
•Long phase 2 w/ lots of inflammation causing scarring, fibrosis & cirrhosis then will see cirrhosis
•Can remain in this stage indefinitely, some may completely clear virus while others go back to reactivation

Phase 4 - Reactivation
•Same as immune clearance stage but making e antigen as opposed to e virus
•Could be due to immunosuppressive agents or spontaneously due to mutations of the virus which prevents virus from making e antigen - pre-core mutants
•New virus made and immune system tries to destroy them and active viral infection again
•Fluctuating course, remissions occur but rarely sustained
•Treatment is lifelong