Viral hepatitis can be asymptomatic or it can present with malaise and weakness, nausea and anorexia, jaundice, or dark urine. Lab studies show markedly elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Diagnosis is by serology.
Acute viral hepatitis is viral hepatitis with signs and symptoms for <6 months. It can be caused by any of the hepatitis viruses.
Microscopically, the liver shows lobular disarray, hepatocyte swelling (balloon cells), apoptotic hepatocytes (Councilman bodies), lymphocytes in portal tracts and in the lobule, hepatocyte regeneration, and cholestasis.
Chronic viral hepatitis is viral hepatitis with signs and symptoms for >6 months. It can be caused by hepatitis viruses B, C, and D.
• Microscopically, chronic persistent hepatitis shows inflammation confined to portal tracts.
• Chronic active hepatitis shows inflammation spilling into the parenchyma, causing interface hepatitis (piecemeal necrosis of limiting plate).
Hepatitis B often has “ground glass” hepatocytes (due to cytoplasmic HBsAg).