re persistent vs chronic in article blue cis pitt edu doyle pitt edu howard r doyle writes being a chronic hbsag carrier does not necessarily mean the patient has chronic persistent anything persons who are chronic carriers may have no clinical biochemical or histologic evidence of liver disease or they may have chronic persistent hepatitis chronic active hepatitis cirrhosis or hepatocellular carcinoma most cases of chronic persistent hepatitis cph are probably the result of a viral infection although in a good number of cases the cause cannot be determined the diagnosis of cph is made on the basis of liver biopsy it consists of findings of portal inflammation an intact periportal limiting plate and on occasion isolated foci of intralobular necrosis but in contrast to chronic active hepatitis cah there is no periportal inflammation bridging necrosis or fibrosis cph has indeed an excellent prognosis if i had to choose between cah and cph there is no question i would also choose cph however as david pointed out the distinction between the two is not as neat as some of us would have it the histology can sometimes be pretty equivocal with biopsies showing areas compatible with both cph and cah maybe it is a sampling problem maybe it is a continuum i don t know darn just when i think i understand something someone who knows the pathology has to burst my bubble we d better not start talking about glomerular diseases then i ll really get depressed seriously though i wonder how someone with cph would end up getting a biopsy in the first place my understanding and feel free to correct me is that the enzymes are at worst mildly elevated with overall normal hepatic function i would think that the only clue might be a history of prior hepb infection and a positive hepb sag or is it indeed on a continuum with cah and the distinction merely one of pathology and prognosis but otherwise identical clinical features kenneth gilbert university of pittsburgh general internal medicine dammit not a programmer
