Modern Concepts of Acute and Chronic Hepatitis

I. Acute Hepatitis.- 1. History of Acute Viral Hepatitis.- Hepatitis A.- Hepatitis B.- Hepatitis D Virus.- Non-A, Non-B Hepatitis.- Epidemie Non-A, Non-B Hepatitis.- Conclusion.- References.- 2. The Clinical Features of Acute Viral Hepatitis.- Inapparent Asymptomatic Hepatitis.- Symptomatic Hepatitis.- Prodromal Features.- Icteric and Convalescent Phases.- Clinical Variants.- Cholestatic Hepatitis.- Relapsing Hepatitis.- Conclusion.- References.- 3. Histopathology and Ultrastructural Features of Acute Hepatitis.- Morphology of Cellular Alterations in Hepatitis.- Hepatocellular Degeneration, Necrosis, and Regeneration.- Cholestasis, Bile Ductular Proliferation, and Bile Duct Changes.- Sinusoidal Cell Activation and Lobular Inflammation.- Portal Inflammation.- Fibrosis.- Evolution of Acute Viral Hepatitis.- Characteristic Histologic Features.- Different Forms of Acute Viral Hepatitis.- Evidence for Transition to Chronicity.- Differentiation and Immunopathology of Acute Viral Hepatitis, Types A, B, and Non-A, Non-B.- Role of the Liver Biopsy in Differential Diagnosis.- References.- 4. Viral Hepatitis: Extrahepatic Manifestations.- Serum Sickness Prodrome of Acute Viral Hepatitis.- Glomerulonephritis.- Polyarteritis and Other Forms of Vasculitis.- Cryoglobulinemia.- Syndromes Possibly Associated with Viral Hepatitis.- Myocarditis.- Neurologic Disease.- References.- 5. The Serology of Viral Hepatitis: Making Sense out of Alphabet Soup.- Serology of Hepatitis A.- Serology of Hepatitis B.- Classic Considerations.- False-Positive Anti-HBs.- Clinical Value of HBeAg/Anti-HBe.- Clinical Value of IgM-Specific Anti-HBc.- Serology of Hepatitis NANB.- Conclusion: The Bottom of the Bowl.- References.- 6. Modern Concepts of Hepatitis A.- What Is Hepatitis A?.- How Is Hepatitis A Diagnosed?.- Is Hepatitis A Important?.- What Is Hepatitis A Virus?.- How Does Hepatitis A Virus Cause Disease?.- Should HA Be Prevented?.- How Can HAV Infection Be Prevented?.- Can HAV Infection Be Treated?.- What Are the Unanswered Questions Concerning HAV?.- References.- 7. Acute Viral Hepatitis: Hepatitis B.- Histopathologic Features of Acute Hepatitis B.- General Overview of Histopathologic Lesions.- Hepatocellular Necrosis and Inflammation.- Variants and Stages of Acute Hepatitis.- Histologic Prediction of Chronicity.- Bridging Hepatic Necrosis as a Predictor of Chronicity.- Piecemeal Necrosis as a Predictor of Chronicity.- References.- 8. Hepatitis Delta Virus in Acute and Chronic Liver Disease.- Biology, Transmission, and Epidemiology of Hepatitis Delta Virus.- Biology.- Transmission.- Epidemiology.- Acute HDV Hepatitis.- HBV and HDV Co-Infection.- HDV Superinfection of an HBsAg Carrier.- Chronic HDV Hepatitis.- Clinical, Serologic, and Histologic Features.- Natural History of Chronic HDV Hepatitis.- Diagnosis, Therapy, and Prophylaxis.- Diagnosis.- Therapy.- Prophylaxis.- References.- 9. Non-A, Non-B Hepatitis.- Etiology.- Agent.- Serologic Tests.- Multiple Agents?.- Clinical Course.- Acute NANB Hepatitis.- Chronic NANB Hepatitis and Sequelae.- Clinical Diagnosis.- Epidemiology.- NANB Posttransfusion Hepatitis.- Sporadic Endemic NANB Hepatitis.- Epidemic NANB Hepatitis.- Summary.- References.- 10. Uncommon Forms of Viral Hepatitis.- Varicella-Zoster.- Clinical Features.- Diagnosis.- Liver Histology.- Herpes Simplex.- Clinical Features.- Laboratory Features.- Diagnosis.- Liver Histology.- Treatment.- Outcome.- Cytomegalovirus.- Clinical and Laboratory Features.- Diagnosis.- Liver Histology.- Treatment.- Outcome.- Epstein-Barr Virus.- Clinical Features.- Laboratory Features.- Diagnosis.- Liver Histology.- Treatment.- Outcome.- References.- 11. Acute Viral Hepatitis: Treatment.- Uncomplicated Viral Hepatitis.- Hospitalization.- Isolation.- Restriction of Activity.- Diet.- Specific Therapy.- Supportive Measures.- Use of Other Medications.- Alcohol.- Elective Surgery.- Cholestatic Hepatitis.- Subacute Fulminant Hepatitis.- Fulminant Hepatitis.- References.- 12. Prognosis of Acute Viral Hepatitis: Now You Got It, Now You Don't (or Do You?).- Prognosis of Acute Hepatitis A.- Prognosis of Acute Hepatitis B.- Prognosis of Acute Non-A, Non-B Hepatitis.- Prognostication of Prognosis.- Conclusions.- References.- 13. Hepatitis Prophylaxis.- Immunoglobulin for Passive Immunization.- Hepatitis A.- Immunoglobulin Usage.- Hepatitis A Vaccines.- Hepatitis B.- Immunoglobulin Usage.- Hepatitis B Vaccines.- Delta Hepatitis.- Non-A, Non-B (NANB) Hepatitis.- Sterilization or Disinfection of Instruments and Work Areas.- Fear of AIDS.- References.- 14. Toxic And Drug-Induced Hepatitis.- Classification of Drug-Induced Liver Injury.- Biotransformation of Drugs.- Mechanism of Direct-Acting Toxins.- Histopathologic Classification.- Clinical Features of Drug-Induced Hepatitis.- Halothane.- Isoniazid.- Sodium Valproate.- Acetaminophen.- Ketoconazole.- Diphenylhydantoin Hepatotoxicity.- ?-Methyldopa.- Pyrimethamine-Sulfadoxine.- Conclusion.- References.- II. Chronic Hepatitis.- 15. Chronic Hepatitis: Classification.- Background.- Chronic Active Hepatitis.- Types Identified and Prognosis.- Differentiation and Diagnosis.- Differential Diagnosis.- Chronic Persistent Hepatitis.- Types Identified and Prognosis.- Etiology.- Clinical Findings.- Diagnosis.- Differential Diagnosis.- References.- 16. History of Chronic Hepatitis.- 17. Mechanisms of Chronic Hepatitis.- Biochemical Derangements.- Histopathologic Derangements.- Immunologic Derangements.- Humoral Immune Abnormalities.- Cellular Immune Abnormalities: General Remarks.- Helper (CD4+) T Cells.- Cytotoxic (CD8+) T Cells.- Suppressor (CD8+) T Cells.- Genetic Background.- Comparable Diseases.- Animal Models.- Models of Autoimmune Hepatitis.- Mechanisms of Hepatocellular Injury in CAH.- Autoimmune CAH.- HBV-Associated CAH.- References.- 18. Chronic Hepatitis: Histopathology.- Chronic Active Hepatitis.- Chronic Persistent Hepatitis.- Chronic Lobular Hepatitis.- Chronic Septal Hepatitis.- Immunopathology,.- Variants of Chronic Active Hepatitis.- CAH with Abnormal Bile Duct Epithelium.- CAH with Confluent Necrosis.- Transition to Cirrhosis.- Role of the Liver Biopsy in Differential Diagnosis.- References.- 19. Chronic Persistent Hepatitis and Chronic Lobular Hepatitis.- Chronic Persistent Hepatitis.- Definition.- Clinicopathologic Features.- Differential Diagnosis.- Chronic Lobular Hepatitis.- Definition.- Clinicopathologic Features.- Differential Diagnosis.- Final Comments.- References.- III. Chronic Active Hepatitis.- 20. Clinical Features of Chronic Active Hepatitis.- Demographic Features.- Symptoms.- Physical Findings.- Associated Autoimmune Disorders.- Biochemical Features.- Immunoserologic Features.- Genetic Predispositions.- Clinical Implications of Histologic Findings.- Diagnostic Pitfalls.- References.- 21. Associated Conditions in Chronic Hepatitis.- Idiopathic (Autoimmune) Chronic Hepatitis.- Idiopathic Hepatitis versus Chronic Cholestatic Disease.- Chronic Type B Hepatitis.- Chronic Non-A, Non-B Hepatitis.- Metabolic Causes of Chronic Hepatitis.- Drug-Induced Chronic Hepatitis.- Summary.- References.- 22. Chronic Active Hepatitis: Diagnostic Approach.- Clinical Considerations.- Liver Blood Tests.- Aminotransferase.- ?-Glutamyltransferase.- Globulin.- Albumin.- Alkaline Phosphatase.- Bilirubin.- Initial Evaluation.- Differential Diagnosis.- Viral Hepatitis.- Non-A, Non-B Hepatitis.- Wilson's Disease.- Hemochromatosis.- ?1-Antitrypsin Deficiency.- Immunologic CAH.- Primary Biliary Cirrhosis.- Primary Sclerosing Cholangitis.- References.- 23. Chronic Active Hepatitis: Management.- and Perspective.- Chronic Persistent Hepatitis.- Autoimmune Chronic Active Hepatitis.- Periportal Hepatitis (Mild Chronic Active Hepatitis).- Moderate and Severe Chronic Active Hepatitis (Periportal Hepatitis with Bridging or Multilobular Necrosis).- Wilson's Disease.- ?1-Antitrypsin Deficiency.- Primary Biliary Cirrhosis.- Hepatitis B Chronic Active Hepatitis.- Hepatitis D Chronic Active Hepatitis.- Non-A, Non-B (NANB) Chronic Active Hepatitis.- Nonspecific Chronic Active Hepatitis.- Management without Biopsy.- References.- 24. Chronic Active Hepatitis: Prognosis.- Chronic Persistent Hepatitis.- Chronic Portal and Lobular Hepatitis.- Inactive Periportal Hepatitis.- Chronic Active Hepatitis.- Periportal Hepatitis.- Periportal Hepatitis with Bridging and/or Multilobular Necrosis Moderate to Severe CAH.- Cirrhosis.- References.