Fibrosis in chronic hepatitis

Tab. 34.2 Grades of activity and stages of fibrosis in chronic hepatitis (with abbreviations of classification G 1—4, S 0—3)...

Bedossa, P., Dargere, D., Paradis, V. Sampling variabihty of hver fibrosis in chronic hepatitis C. Hepatology 2003 38 1449-1457... 

Paradis V, Mathurin P, Laurent A, Charlotte F, Vidaud M, Poynard T, et al. Histological features predictive of liver fibrosis in chronic hepatitis C infection. J Clin Pathol 1996 49 998-1004. 

Trinchet J. Clinical use of serum markers of fibrosis in chronic hepatitis. J Hepatol 1995 22 89-95,... 

A fibrotic widening of the portal fields (with differing intensity and often variable regional distribution) is a frequent finding in chronic hepatitis, and it plays an important role in staging, (s. p. 694) However, it may also be a remnant of previous hepatitis. In many cases, strands of connective tissue extend into the periportal parenchyma. Mostly, there is portal/periportal fibrosis with an irregular star-shaped pattern, (s. fig. 21.14)... 

Central venules only contain a small amount of collagen, with the result that in this form of fibrosis, perivenous sinusoids are always involved as well. A typical example is perivenular fibrosis in chronic alcohol abuse, (s. fig. 21.16) Centrolobular fibrosis may also be detectable in healed viral hepatitis or following slight liver damage (e.g. Meulengracht s disease). Central hyaline sclerosis, which is due to chronic alcohol abuse with intermittently recurring alcohol hepatitis, is known to be a particularly severe form of fibrosis, (s. p. 526)... 

The morphological spectrum may therefore range from steatosis, acute hepatitis, fulminant course, chronic hepatitis, aggressive episodes in chronic hepatitis and liver fibrosis through to micronodular cirrhosis. Complete cirrhosis can already exist in children aged 4-5 years. The development of hepatocellular carcinoma is extremely rare (360) it is assumed that copper has a protective effect against malignant transformation. (391,393)... 

Crespo, J., Rivero, M., Fabrega, E., Cayon, A., Amado, J.A., Garcia-Unzeta, M.T., Pons-Romero, F. Plasma leptin and TNF-alpha levels in chronic hepatitis C patients and their relationship to hepatic fibrosis. Dig. Dis. Sci. 2002 47 1604-1610... 

McCaughan, G.W., George, J. Fibrosis progression in chronic hepatitis C virus infection. Gut 2004 53 318—321... 

Piche, T., Vandenbos, F., Abakar-Mahamat, A., Vanbiervllet, G., Bar-joan, E.M., Calle, G., Giudicelli, J., Ferrua, B., Laffont, C., Benzaken, S., Tran, A. The severity of Uver fibrosis is associated with high leptin levels in chronic hepatitis C. J. Viral Hepat. 2004 11 91-96... 

Wong N, et al. Prediction of Ever fibrosis and cirrhosis in chronic hepatitis B infection by serum proteomic fingerprinting A pilot study. Clin Chem 2005 51 In Press. 

Liver Daily cannabis use may be a susceptibility factor for steatosis in chronic hepatitis C, an important consideration, since steatosis has been reported to increase fibrosis and reduce the rate of viral eradication. In 315 consecutive patients with chronic hepatitis C tmdergoing Uver biopsy collected, the patients were categorized as non-users (64%), occasional users (12%), and daily users (24%) [18. After alcohol intake and viral genot5rpe were controlled for, marked steatosis (at least 30% of... 

Detailed sub-analyses of a variety of clinical trials have provided information about host and viral factors influencing the virologic response in the treatment of chronic hepatitis C. The most important factors include the HCV genotype, HCV RNA concentration at baseline, age, weight, gender, ethnicity, liver enzymes, and stage of fibrosis (Mihm et al. 2006 Pawlotsky 2005). 

Poynard, T., J. McHutchison, G.L. Davis, Esteban, R. Mur, Z. Goodman, P. Bedossa, and J. Albrecht, Impact of interferon alfa-2b and ribavirin on progression of liver fibrosis in patients with chronic hepatitis C. Hepatology, 2000.32 1131-7. 

Hepatitis C virus (HCV) was discovered in 1989 and has been regarded as the key causative agent for non-A, non-B virus hepatitis (33-35). It is estimated that there are over 170 million people worldwide and about 4 million individuals in United States with chronic HCV infection (36). Majority of the infected persons (80%) develop chronic hepatitis, where about 10-25% of them could advance to serious HCV-related liver diseases such as fibrosis, cirrhosis, and hepatocellular carcinoma (37). Only a fraction of patients respond to current FDA-approved standard therapy with a sustained viral load reduction (38), and many of them could not tolerate the treatment because of the various severe side effects (39). Therefore, HCV still represents an unmet medical need which requires discovery and development of more effective and well-tolerated therapies. 

Herold C, Heinz R, Niedobitek G, Schneider T, Hahn EG, Schuppan D. Qiiantitative testing of liver function in relation to fibrosis in patients with chronic hepatitis B and C. Liver 2001 21 260-5. 

Fig. 2.3 Reticular fibrosis of the liver surface in chronic persistent hepatitis B with a so-called simian cleft (s. fig. 31.20)...

Chronic liver diseases may show protracted (subchronic), persistent or aggressive courses. The new classification of chronic hepatitis emphasizes its respective aetiology while at the same time categorizing the degree of inflammatory and necrotic activity as well as any fibrosis and additional changes in the hepatic architecture. 

Fig. 28.11 Chronic moderate periportal and portal inflammatory reaction with septal fibrosis and centrilobular steatosis in chronic alcoholic liver damage (DD mild chronic viral hepatitis C ) (van Gieson)...

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