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Chronic hepatitis Clinically, this is defined as any hepatitis lasting > 6 months. Pathology: Chronic inflammatory cell infiltrates comprising lymphocytes and plasma cells are usually present in the portal tracts. The amount of inflammation varies from mild to severe. In addition, there may be: Periportal or periseptal interface hepatitis Lobular change, focal lytic necrosis, apoptosis and focal inflammation Confluent necrosis Fibrosis which may be mild, bridging (across portal tracts) or severe Cirrhosis The overall severity of the hepatitis is judged by the degree of necrosis and inflammation and the severity of the fibrosis or cirrhosis. Causes of chronic hepatitis: Viral: Hepatitis B ± Delta virus Hepatitis C Autoimmune: Drugs: Methyldopa Isoniazid Ketoconazole Nitrofurantoin Hereditary: α1-antitrypsin deficiency Wilson’s disease Others: Ulcerative colitis Alcohol (rarely) Clinical features of chronic liver disease: Xanthelasmas (yellow plaques occurring symmetrically around the eyelids) Parotid enlargement Spider naevi Gynaecomastia Small/large liver Splenomegaly Clubbing Scratch marks Testicular atrophy Purpura Oedema Chronic hepatitis Caput medusae Ascites Jaundice Fever Loss of body hair Fetor hepaticus Hepatic flap Disorientation Drowsiness |
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