Pathologic anatomy

Chronic hepatitis. The most constant with active chronic hepatitis are changes portal tracts and periportal fields. They expanded, infiltrated by lymphocytes, histiocytes, plasma cells. Proliferating cells form fibroblasts. An increasing number of collagen fibers in the periportal fields, there is a consolidation, growth and collagenase reticulin fibers. Portal tracts lengthened AgroBalt, acquire star-shaped form (Fig. 60). As the progression of the process of cell infiltrates and connective tissue bands penetrate into slices. Connecting with each other and with the bands, formed around a Central vein, they gut the hepatic segment. This stage of the process can be considered as the moment of transition of chronic hepatitis b portal cirrhosis of the liver.

Fig. 60. Chronic hepatitis. Explanation in the text.

Often detected protein degeneration of hepatocytes, acidophilus and gigroskopicna their damage. During exacerbations come focal necrosis parenchyma mainly on the periphery of the lobules. Regeneration of liver cells is active and more pronounced on the periphery of the liver lobules. Characterized by the proliferation of false bile ducts. Often found persistent intrahepatic disorder bile secretion, especially in the period of exacerbation of the pathological process.
For not progressing, the so-called benign chronic hepatitis is characterized by the presence only of degenerative changes in the liver cells, primarily vacuolar hydropic dystrophy (M. E. Semendyaeva, 1970).
A special place among the various forms of chronic hepatitis is the so-called cholestatic hepatitis, first described Watson and Hoffbauer (1946) as a variant of the flow of viral hepatitis. The morphological study of the liver in these cases, along with signs of chronic hepatitis, attention is drawn to the signs of pronounced intrahepatic cholestasis.
Due to the progression of cholestatic hepatitis develops biliary cirrhosis.
Dynamics of pathomorphological changes in chronic hepatitis of different possible stabilization of the pathological process, sometimes even devolution through changes may and progression.
Periods of stabilization of chronic hepatitis may take different time. In the long inactivity pathological process in the liver detected residual fibrosis (E. N. Ter-Grigorova, 1963; Popper, Schaffner, 1957) or comes back the development of morphological changes.
The possibility of reduction of fibrosis and restore structure of the liver parenchyma in experimental cirrhosis after the termination of toxic effects or after replacing terrigenous normal diet (C. D. Sarkisov, HP Rubezhi, 1960; Pechet, MacDonald, 1961).
Changes macroscopic picture of the liver, consistently occur when the progression of chronic hepatitis described Kalk (1950, 1957) on the basis of laparoscopic observations.
So, type of liver, laparoscopic find in viral hepatitis, referred to as "big red liver: the liver with a blunt edge, increased, its surface is red, smooth, serous membrane hyperemic. At this stage it is possible to recover to normal. With the progression of the process, the liver remains large, the region it is pointed, the surface of the liver becomes grayish-white ("big white liver").
Further development of chronic hepatitis is characterized by the decrease of the liver, on the surface appear round reddish areas from one to two or more inches in diameter, located on the brown and gray-white background of the rest of the surface of the liver ("large colorful liver"). Further develops the "big nodular liver: the liver seems to be very dense, over its surface are small reddish nodes (nodular regenerated parenchyma), later receiving brown. Essentially, the "great knobbly liver" characterizes the initial stage of cirrhosis.