Which of the following is Single most important indicator of likelihoodness of progression of hepatitis to liver cirrhosis?
Etiology
Associated serological findings
Presence of bridging necrosis
Presence of Mallory hyaline
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.
Liver & Biliary Tract