Hepatitis, Chronic Active
Basic Information 
Clinical Presentation
Disease Forms/Subtypes
• Most commonly subtle and gradual in onset.
• Two forms of chronic active hepatitis are described based on the predominant cell population within the liver inflammatory infiltrate:
Neutrophilic infiltration, indicative of a suppurative hepatitis. This type of hepatitis is frequently associated with biliary stasis and hyperplasia and is consistent with a histopathologic diagnosis of cholangitis or cholangiohepatitis (see also “Cholangiohepatitis, Chronic, and Biliary Fibrosis” in this section).Etiology and Pathophysiology
Idiopathic; the etiology is often undetermined. Possible causes include:
• Bacterial infection (hematogenous or ascending from the gastrointestinal tract)
• Based on the distribution of the lesions predominantly in the area surrounding the portal triad, delivery of noxious agents (eg, bacteria, viruses, endotoxins, toxic agents, inflammatory mediators, or a combination of these) via the portal vein is hypothesized. The presence of inflammatory cells in the periportal area would then be explained by extravasation from the hepatic arterioles or lymphatic vessels in response to the primary insult.
Diagnosis 
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