Acute Viral Hepatitis and Its Key Pathological Features

The hallmark pathological changes of acute viral hepatitis primarily involve liver cell damage, including cellular degeneration and swelling. The most common types of degeneration observed are ballooning degeneration and eosinophillic changes. Due to the diffuse nature of the disease, liver cells swell and their internal enzymes, particularly alanine aminotransferase (ALT), can leak out of the cells and enter the bloodstream. This leakage leads to elevated levels of ALT in biochemical tests, which is a key indicator of liver damage.

In addition to ALT, liver cell organelles may also be affected. When organelles are injured, aspartate aminotransferase (AST), an enzyme located within them, can also be released into the blood. As a result, increased AST levels further reflect the extent of cellular damage. In patients with acute viral hepatitis, both ALT and AST levels are typically elevated, and the degree of elevation often correlates with the severity of liver injury.

Beyond cellular swelling and ballooning changes, acute viral hepatitis may also cause focal necrosis—localized areas of dead or dying liver cells. The extent of necrosis is closely linked to the severity of the illness. More severe necrosis usually translates to more pronounced symptoms and greater impairment of liver function. Elevated liver enzymes and abnormal liver function tests are thus reliable markers of disease progression. Monitoring these biochemical indicators is essential for assessing the condition and guiding treatment decisions.