interface hepatitis help needed understanding

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ramajama2003

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I dont understand the term interface hepatitis, i realise that it is a form of necrosis associated with chronic viral hepatitis infection and it involves inflammation of the portal tract and it causes disruption to the connective tissue around the portal tract and that the inflmmation which is localised to the inflamed portal tracts attacks and destroys the periportal hepatocytes

the gross morphology of piece meal necrosis is a moth bitten appearance and we can diagnose the severity of interface hepatitis by the number of necrotised/inflamed portal tracts in the liver parenchyma.

Is there something i'm lacking, i dont understand the point in this, its a special type of necrosis that effects the portal tracts and is associated mainly with chronic viral infection?

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I think you are confused by the Ishak grading system which is used mainly for grading hepatitis C, is way too complex and you most likely don't need it as a medical student. Here's a more simplistic approach that is easy to use. This can be used with any type of hepatitis - viral, autoimmune, metabolic etc.

Look for inflammatory cells in the biopsy and see where they are located. No inflammatory cells or scattered rare ones in the portal tracts - no hepatitis. Inflammatory infiltrate confined to the portal tracts - portal inflammation. Inflammatory cells spilling from the portal tracts into adjacent liver parenchyma (the limiting plate, or two to three rows of hepatocytes next to the portal tracts) - interface inflammation. Inflammatory cells can be found in hepatic lobules beyond the limiting plate - lobular inflammation.
 
Also, don't be confused by the term "necrosis" in piecemeal necrosis. It isn't necrosis like you are probably thinking of (coagulative necrosis, etc).
 
I think you are confused by the Ishak grading system which is used mainly for grading hepatitis C, is way too complex and you most likely don't need it as a medical student. Here's a more simplistic approach that is easy to use. This can be used with any type of hepatitis - viral, autoimmune, metabolic etc.

Look for inflammatory cells in the biopsy and see where they are located. No inflammatory cells or scattered rare ones in the portal tracts - no hepatitis. Inflammatory infiltrate confined to the portal tracts - portal inflammation. Inflammatory cells spilling from the portal tracts into adjacent liver parenchyma (the limiting plate, or two to three rows of hepatocytes next to the portal tracts) - interface inflammation. Inflammatory cells can be found in hepatic lobules beyond the limiting plate - lobular inflammation.

i was wondering since the portal system just delivers blood to the hepatic lobules via the sinusoids why is the inflmmation initially localised in the portal tract when the portal tract is just a delivery system? i would have thought that the inflammation would occur inside the lobules and can chronic alcholism which is known to cause macrovesicular steatosis result in interface hepatitis? and what autoimmune agents can ellict interface hepatitis?
thanks
 
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