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OVERVIEW

Common to all forms of chronic hepatitis are histopathologic distinctions based on localization and extent of liver injury. These vary from the milder forms, previously labeled chronic persistent hepatitis and chronic lobular hepatitis, to the more severe form, formerly called chronic active hepatitis. When first defined, these designations were believed to have prognostic implications, which were not corroborated by subsequent observations. Categorization of chronic hepatitis based primarily on histopathologic features has been replaced by a more informative classification based on a combination of clinical, serologic, and histologic variables. Classification of chronic hepatitis is based on (1) its cause; (2) its histologic activity, or grade; and (3) its degree of progression based on level of fibrosis, or stage. Thus, neither clinical features alone nor histologic features—requiring liver biopsy or noninvasive markers of fibrosis—alone are sufficient to characterize and distinguish among the several categories of chronic hepatitis.

CLASSIFICATION OF CHRONIC HEPATITIS BY CAUSE

Clinical and serologic features allow the establishment of a diagnosis of chronic viral hepatitis, caused by hepatitis B, hepatitis B plus D, or hepatitis C; autoimmune hepatitis, including several subcategories, I and II, based on serologic distinctions; drug-associated chronic hepatitis; and a category of unknown cause, or cryptogenic chronic hepatitis (Table 334-1). These are addressed in more detail below.

TABLE 334-1Clinical and Laboratory Features of Chronic Hepatitis

CLASSIFICATION OF CHRONIC HEPATITIS BY GRADE

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