Which of the following is Single most important indicator of likelihoodness of progression of hepatitis to liver cirrhosis?
Ans. a (Etiology) (Ref Robbins 7th/898)Robbins 7th/p. 898:# The single most indicator of the likelihoodness of rapid progression chronic hepatitis to cirrhosis is underlying etiology.# 'Interface hepatitis and bridging necrosis' are harbingers of progressive liver diseases in patients with any form of chronic hepatitis.HISTOLOGIC FEATURES OF ACUTE HEPATITIS# Inflammation is a characteristic and usually prominent feature of acute hepatitis.# In severe cases of acute hepatitis, confluent necrosis of hepatocytes may lead to bridging necrosis connecting portal-to-portal, central-to-central, or portal-to-central regions of adjacent lobules.# Kupffer cells undergo hypertrophy and hyperplasia and are often laden with lipofuscin pigment due to phagocytosis of hepatocellular debris.# The portal tracts are usually infiltrated with a mixture of inflammatory cells.# The inflammatory infiltrate may spill over into the adjacent parenchyma to cause necrosis of periportal hepatocytes; this "interface hepatitis" can occur in both acute and chronic hepatitis.# Finally, bile duct epithelia may become reactive and even proliferate to form poorly defined ductular structures (ductular reaction), particularly in cases of HCV hepatitis.HISTOLOGIC FEATURES OF CHRONIC HEPATITIS# In the mildest forms, significant inflammation is limited to portal tracts and consists of lymphocytes, macrophages, occasional plasma cells, and rare neutrophils or eosinophils.# Liver architecture is usually well preserved, but smoldering hepatocyte necrosis throughout the lobule may occur in all forms of chronic hepatitis.# Even in mild chronic hepatitis due to HCV infection, common findings are lymphoid aggregates and bile duct damage in the portal tracts and focally mild to moderate macrovesicular steatosis.# In all forms of chronic hepatitis, continued interface hepatitis and bridging necrosis are harbingers of prog, liver damage.# The hallmark of irreversible liver damage is the deposition of fibrous tissue.# At first, only portal tracts exhibit increased fibrosis, but with time, periportal septal fibrosis occurs, followed by linking of fibrous septa between lobules (bridging fibrosis).# Continued loss of hepatocytes and fibrosis results in cirrhosis, with fibrous septae and hepatocyte regenerative nodules.
Etiology
Associated serological findings
Presence of bridging necrosis
Presence of Mallory hyaline
Liver & Biliary Tract