: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.
