The ABCs of chronic hepatitis: reason out of confusion

Chronic hepatitis is defined as a condition in which liver injury tests (aminotransferases or cholestatic enzymes such as alkaline phosphatase) are abnormal on several occasions (usually determined monthly) for more than 6 months. The causes or the disease processes that can lead to chronic hepatitis are numerous, making the diagnosis and particularly the evaluation of patients with chronic hepatitis difficult or even mystical for those who do not identify themselves primarily as hepatologists. It is for these latter individuals (the bulk of practicing gastroenterologists and physicians in other primary fields) that the following editorial is written. It is hoped that a structured approach to the problem of chronic hepatitis will enable these physicians to make decisions concerning specific disease etiologies and, as a result, medical therapies for chronic hepatitis for their patients and that these decisions be both rational and simple. The system to be presented has been utilized by the author for over a decade and has been found to be very useful in training medical and surgical house officers as well as gastroenterology fellows and has been equally useful for the faculty of gastroenterology and hepatology programs. It is currently being used in Oklahoma at the Oklahoma Transplantation Institute and Hepatic and Digestive Diseases Center of Baptist Hospital in Oklahoma City.