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A 34-year-old male returns from a trip to India and develops anorexia, mild nausea, and dark urine lasting two days. Physical examination reveals low-grade fever and mild right upper abdominal quadrant tenderness. A liver biopsy is most likely to show which of the following?
A. Liquefaction necrosis
B. Ballooning degeneration
C. Invasive cells
D. Fibrinoid necrosis
E. Regeneration nodules
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got it wrong it is B
councillman bodies
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This patient has the classic symptoms of acute viral hepatitis: low-grade fever, anorexia, nausea, dark colored urine, and right upper quadrant tenderness. Hepatitis A virus (HAV) is most likely responsible since the patient has just returned from a region where it is endemic. HAV is the most common cause of acute viral hepatitis in young adults. In all cases of acute viral hepatitis, diffuse ballooning degeneration (hepatocyte swelling), mononuclear cell infiltrates, and Councilman bodies (eosinophilic apoptotic hepatocytes) are seen histologically. (Liver biopsy is not needed to make the diagnosis of HAV infection, however.)
Educational Objective:
Anorexia, nausea, and low-grade fever followed by bilirubinuria and right upper quadrant tenderness suggest acute hepatitis which is most commonly caused by the Hepatitis A virus in young adults. Acute hepatitis due to most hepatotropic viruses causes hepatocyte ballooning degeneration and apoptosis on histologic exam.
