file.newsgroup.med.59648 Maven / Gradle / Ivy
From: [email protected] (Kenneth Gilbert)
Subject: Re: Persistent vs Chronic
In article <[email protected]> [email protected] (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.
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= Kenneth Gilbert __|__ University of Pittsburgh =
= General Internal Medicine | "...dammit, not a programmer!" =
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