re persistent vs chronic in article blue cis pitt edu doyle pitt edu howard r doyle writes chronic persistent hepatitis is usually diagnosed when someone does a liver biopsy on a patient that has persistently elevated serum transaminases months after a bout of acute viral hepatitis or when someone is found to have persistently elevated transaminases on routine screening tests the degree of elevation in the serum transaminases can be trivial or as much as ten times normal other blood chemistries are usually normal as a rule patients with cph have no clinical signs of liver disease chronic active hepatitis can also be asymptomatic or minimally symptomatic at least initially and that s why it s important to tell them apart by means of a biopsy the patient with cph only needs to be reassured the patient with cah needs to be treated i just went back to the chapter in cecil on chronic hepatitis it seems that indeed most cases of cph are persistant viral hepatitis whereas there are a multitude of potential and probable causes for cah viral drugs alcohol autoimmune etc physicians seem to have a variety of thresholds for electing to biopsy someone s liver personally i think that if the patient is asymptomatic with only slight transaminitis and normal albumin and pt one can simply follow them closely and not add the potential risks of a biopsy others may well biopsy such a patient thus providing these samples for study it would be interesting to see if anyone s done any decision analysis on this kenneth gilbert university of pittsburgh general internal medicine dammit not a programmer
