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Difference between revisions of "Hepatitis B"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Ground_glass_hepatocytes_high_mag_cropped_2.jpg | |||
| Width = | |||
| Caption = Ground glass hepatocytes in chronic hepatitis B. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = lobular inflammation - hepatocyte necrosis, +/-[[ground glass hepatocytes]] | |||
| Subtypes = | |||
| LMDDx = [[hepatitis C]], [[autoimmune hepatitis]], [[primary biliary cholangitis]] without [[granulomas]], [[drug-induced liver disease|drug reaction]] | |||
| Stains = [[Shikata stain]] +ve (not sensitive) | |||
| IHC = hepatitis B +ve | |||
| EM = | |||
| Molecular = HBV DNA present (serum) | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Staging = | |||
| Site = [[liver]] - see ''[[medical liver disease]]'' | |||
| Assdx = [[cirrhosis]], [[hepatocellular carcinoma]], [[polyarteritis nodosa]] (PAN), [[membranoproliferative glomerulonephritis]], [[membranous nephropathy]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = common - especially in Asia | |||
| Bloodwork = HBs Ag, HBs Ab, HBe Ag, HBe Ab - see ''[[Medical_liver_disease#Hepatitis_B]]'' | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = other hepatitides - viral and non-viral | |||
| Tx = prevention through vaccination, medical treatments (pegylated interferon and nucleoside analogues) | |||
}} | |||
'''Hepatitis B''' is a relatively common [[medical liver disease]] caused by the ''hepatitis B virus''. | '''Hepatitis B''' is a relatively common [[medical liver disease]] caused by the ''hepatitis B virus''. | ||
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*High prevalence. | *High prevalence. | ||
*Diagnosis is by serology - details of serologic testing are in the ''[[Medical_liver_disease#Hepatitis_B|medical liver disease article]]''. | *Diagnosis is by serology - details of serologic testing are in the ''[[Medical_liver_disease#Hepatitis_B|medical liver disease article]]''. | ||
*A vaccination is available and done routinely in a many jurisdictions.<ref>{{Cite journal | last1 = Leuridan | first1 = E. | last2 = Van Damme | first2 = P. | title = Hepatitis B and the need for a booster dose. | journal = Clin Infect Dis | volume = 53 | issue = 1 | pages = 68-75 | month = Jul | year = 2011 | doi = 10.1093/cid/cir270 | PMID = 21653306 }}</ref> | *A vaccination is available and done routinely in a many jurisdictions.<ref name=pmid21653306>{{Cite journal | last1 = Leuridan | first1 = E. | last2 = Van Damme | first2 = P. | title = Hepatitis B and the need for a booster dose. | journal = Clin Infect Dis | volume = 53 | issue = 1 | pages = 68-75 | month = Jul | year = 2011 | doi = 10.1093/cid/cir270 | PMID = 21653306 }}</ref> | ||
*Medical treatments available for chronic infection - pegylated interferon and nucleoside analogue therapies.<ref>{{Cite journal | last1 = Su | first1 = TH. | last2 = Kao | first2 = JH. | title = Unmet Needs in Clinical and Basic Hepatitis B Virus Research. | journal = J Infect Dis | volume = 216 | issue = suppl_8 | pages = S750-S756 | month = Nov | year = 2017 | doi = 10.1093/infdis/jix382 | PMID = 29156048 }}</ref><ref name=pmid28052634>{{Cite journal | last1 = Chen | first1 = GF. | last2 = Wang | first2 = C. | last3 = Lau | first3 = G. | title = Treatment of chronic hepatitis B infection-2017. | journal = Liver Int | volume = 37 Suppl 1 | issue = | pages = 59-66 | month = Jan | year = 2017 | doi = 10.1111/liv.13309 | PMID = 28052634 }}</ref> | |||
Associated pathology | ===Associated pathology=== | ||
*[[Polyarteritis nodosa]] (PAN). | *[[Polyarteritis nodosa]] (PAN). | ||
*[[Membranoproliferative glomerulonephritis]]. | *[[Membranoproliferative glomerulonephritis]]. | ||
*[[Membranous nephropathy]]. | *[[Membranous nephropathy]]. | ||
*[[Cirrhosis]]. | |||
*[[Hepatocellular carcinoma]]. | |||
==Microscopic== | ==Microscopic== | ||
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*[[Hepatitis C]]. | *[[Hepatitis C]]. | ||
*[[Autoimmune hepatitis]]. | *[[Autoimmune hepatitis]]. | ||
*[[Primary biliary | *[[Primary biliary cholangitis]] without [[granulomas]]. | ||
*[[Drug-induced liver disease|Drug reaction]]. | *[[Drug-induced liver disease|Drug reaction]]. | ||
**Pseudo-Lafora bodies in patients on disulfiram (anatabuse) can result in [[ground glass hepatocytes]]. | |||
===Image=== | ===Image=== | ||
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Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis). A. A fragmented specimen shows apparent nodules [black arrows]. B. Inflammatory cells extending from band suggest piecemeal necrosis [green arrows]; inflammatory foci apart from band denote spotty necrosis [blue arrows]. C. Reticulin stain shows piecemeal necrosis as black lines about hepatocyte clusters at band [blue arrows], regeneration as more than one cell thick cords [green arrows] and hepatocyte rosettes [magenta arrows]. D. On PAS without diastase, piecemeal necrosis can be seen as pink hepatocyte cytoplasmic fragments amid inflammatory cells [arrows]. E. The nodules seen at low power are confirmed to be collagen bounded, but the appreciation can be made frustrated by intense inflammation. F. Examination elsewhere shows a definite nodule pair amid fibrosis [green arrows]; note on the right the fibrous band extending from the portal triad [black arrow] with sinusoids being far more often perpendicular to the triad than they were in the regenerative nodules to the surrounding bands. | Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis). A. A fragmented specimen shows apparent nodules [black arrows]. B. Inflammatory cells extending from band suggest piecemeal necrosis [green arrows]; inflammatory foci apart from band denote spotty necrosis [blue arrows]. C. Reticulin stain shows piecemeal necrosis as black lines about hepatocyte clusters at band [blue arrows], regeneration as more than one cell thick cords [green arrows] and hepatocyte rosettes [magenta arrows]. D. On PAS without diastase, piecemeal necrosis can be seen as pink hepatocyte cytoplasmic fragments amid inflammatory cells [arrows]. E. The nodules seen at low power are confirmed to be collagen bounded, but the appreciation can be made frustrated by intense inflammation. F. Examination elsewhere shows a definite nodule pair amid fibrosis [green arrows]; note on the right the fibrous band extending from the portal triad [black arrow] with sinusoids being far more often perpendicular to the triad than they were in the regenerative nodules to the surrounding bands. | ||
==Stains== | |||
*[[Shikata stain]] - hepatitis B surface antigen. | |||
**[[Sensitivity]] modest ~20% of serum positive stain positive.<ref name=pmid7822848>{{Cite journal | last1 = Ghosh | first1 = AK. | last2 = Dasgupta | first2 = A. | last3 = Raha | first3 = K. | last4 = Jana | first4 = A. | last5 = Majumdar | first5 = DN. | title = Hepatic histology in chronic liver disease in hepatitis B surface antigen positive cases. | journal = J Indian Med Assoc | volume = 92 | issue = 10 | pages = 333-5 | month = Oct | year = 1994 | doi = | PMID = 7822848 }}</ref> | |||
==IHC== | ==IHC== | ||
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==See also== | ==See also== | ||
*[[Medical liver disease]]. | *[[Medical liver disease]]. | ||
*[[Viruses and cancer]]. | |||
==References== | ==References== | ||