Classification

I. According to causes:

• chronic hepatitis B;

• cronic hepatitis C;

• cronic hepatitis D;

• cronic hepatitis other viral;

• atoimmune hepatitis;

• dug-associated chronic hepatitis;

• cyptogenic chronic hepatitis.

In 40-70 per cent of cases chronic hepatitis develops as an outcome of on acute epidemic or serum hepatitis.

II. Classification by grade or by stage:

0 - no fibrosis;

1 – mild fibrosis;

2 – moderate fibrosis;

3 – severe fibrosis, including bridging fibrosis;

4 – cirrhosis.

III. Classification by according to the index of histologic activity on Knodell in points:

a) periportal hepatocytis necrosis, including the bridge-like - 0-10 points;

b) intrasegmental focal necrosis and hepatocytis dystrophy - 0-4 points;

c) inflammatory infiltrate in portal tracts - 0-4 points;

d) fibrosis - 0-4 points.

The index of histologic activity from 1 up to 6 points testifies to presence of the "minimal" chronic hepatitis, 7-12 points - the "moderate", 13-18 points - a "grave" chronic hepatitis.

IV. Classification by function of the liver on Child-Pugh:

Class A (stage compensation);

Class B (stage subcompensation);

Class C (stage decompensation).

Pathological anatomy

Among diffuse inflammatory affections of the liver benign (non-active, persisting), active and cholestatic chronic hepatitis are distinguished. Non-active hepatitis is characterized by inflammation in the periportal zones, preservation of the lobular structure, and sometimes by moderate dystrophic changes in the hepatocytes. The inflammatory and cicatricial processes are more distinct in the liver affected by active hepatitis. Inflammatory infiltration extends from the periportal zones inside the liver. Hepatocytes are extensively necrotized and have dystrophic changes; fibrosis is found in the liver.

Clinical features

Chronic hepatitis are characterized by dyspeptic symptoms; jaundice; moderate enlargement and induration of the liver; enlargement of the spleen; dysfunction of the liver as determined by laboratory tests and radiohepatography.

But the clinical picture and also the course of each clinico-morphological form of hepatitis have their special features. Chronic benign hepatitis is characterized by obliterated clinical picture. The patients complain of heaviness or dull pain in the right hypochondrium, decreased appetite, bitter taste in the mouth, nausea and eructation. Jaundice is usually absent or it is moderate. Objective studies reveal a mildly enlarged liver with a smooth surface and a moderately firm edge, which is slightly tender to palpation. Enlargement of the spleen is not marked. Laboratory studies: the blood bilirubin content is usually normal; in the presence of jaundice it increases to about 17-50; the blood globulin content is mildly increased, activity of the enzymes is either normal or only slightly changed; the prothrombin content is normal or slightly decreased.

Chronic active hepatitis is characterized by complaints and objective symptoms: weakness, loss of weight, fever, pain in the right hypochondrium, loss of appetite, nausea, regurgitation, meteorism, skin itching, jaundice, and frequent nasal bleeding. The liver is enlarged, firm, with a sharp edge. The spleen is enlarged.