Histology in chronic hepatitis.

The subdivision of chronic hepatitis into chronic persistent hepatitis (CPH) and chronic active hepatitis (CAH) remains the basis for diagnosis, but requires modification and amplification. Mild CAH closely resembles CPH, and corticosteroids may suppress CAH to a picture of CPH. Sampling error may explain some examples of apparent transition from CPH to CAH. The lesion of CPH is non-specific, and other causes of portal inflammation must be excluded. Definition of CAH must incorporate bridging hepatic necrosis (BHN) which speeds development of cirrhosis. Portal/periportal inflammation and necrosis in acute hepatitis remain important predictors of chronicity. CAH varies widely in severity and pathology. Lobular activity may be important in prognosis; when found alone, it constitutes a third type of chronic hepatitis, chronic lobular hepatitis. Chronic hepatitis can be re-classified in a practical way which crosses conventional categories.