The term "
chronic hepatitis" includes diseases of different etiology, i.e. viral (hepatitis B virus, non-A/non-B hepatitis virus[es]),
drug-induced (e.g.
oxyphenisatin,
alpha-methyldopa), metabolic (
Wilson's disease,
alpha 1-antitrypsin deficiency) and so-called "
autoimmune" hepatitis. In the
clinical course,
hepatitis running for up to 3 months is considered acute; when lasting for 3-6 months it is termed prolonged, and
chronic hepatitis means a duration of more than 6 months by definition. In
chronic hepatitis there is international agreement on basing nomenclature on morphologic findings and on distinguishing
chronic persistent hepatitis (with a predominantly lymphocytic
inflammation restricted to portal tracts) from chronic aggressive (or active)
hepatitis. The latter is typified by piecemeal
necrosis in the periportal areas (activity a); additional piecemeal
necrosis along fibrous septa or bridging hepatic necorsis is the key feature for activity b. In
hepatitis B virus infection, the symptomfree carrier of the virus with no
inflammation in biopsy, or merely nonspecific reactive
hepatitis, must be included under the heading of
chronic hepatitis.
Cirrhosis, however, although resulting from
necrosis,
inflammation and fiber formation, refers exclusively to the disturbance of lobular architecture and its microcirculatory consequences. The term "
cirrhosis" is thus not included in the definition of chrome
hepatitis and should be evaluated separately as an entity in its own right.