15. CHRONIC ACTIVE HEPATITIS

Abstract

Publisher Summary The term “chronic active (or aggressive) hepatitis” (CAH), often used interchangeably with “active chronic hepatitis,” owes its origins to World War II. Up to 10% of soldiers returning from the Mediterranean theatre who had contracted (presumed viral) hepatitis were found to be slow to recover and many continued to have signs and symptoms of liver disease long after the initial acute phase. By the late 1960s, with increasing use of percutaneous liver biopsy and biochemical liver tests as diagnostic tools, it became apparent that some patients with CAH had a milder, seemingly less aggressive, form of chronic hepatitis which was described as “chronic persistent hepatitis” (CPH). The latter was defined morphologically as a lymphocytic infiltrate in expanded portal tracts without disruption of the limiting plate or piecemeal necrosis. The chapter presents a discussion of chronic liver disease and wide range of signs and symptoms that are common to most chronic liver disorders. The most frequent complaints are lethargy, often extreme fatigue, accompanied by feelings of general malaise. The cause of the fatigue is unknown but functional changes in the hypothalamic-pituitary-adrenal axis, altered neurotransmission, or disturbances of sleep patterns due to disease-associated complications (for example, severe pruritus) or anxiety, have all been invoked. Other frequent symptoms include persistent or intermittent nausea, anorexia (and consequent weight loss), general abdominal discomfort (with or without pain), pruritus and/or skin rashes, arthralgia and/or myalgia, fluctuating low grade pyrexia, recurrent epistaxes, and menstrual irregularities in women.