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Chronic liver disease in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis.
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Causes
The list of conditions associated with chronic liver disease is extensive and can be categorised in the following way:
Viral causes
- Hepatitis B
- Hepatitis C
- Cytomegalovirus (CMV)
- Epstein Barr Virus (EBV)
Toxic and drugs
- Alcoholic Liver Disease
- Amiodarone
- Methotrexate
- Nitrofurantoin
Metabolic
- Non-Alcoholic Fatty Liver Disease
- Haemochromatosis
- Wilson's Disease
Autoimmune
- Autoimmune Chronic Hepatitis
- Primary Biliary Cirrhosis
- Primary Sclerosing Cholangitis
Other
- Right Heart Failure
Complications of chronic liver disease
- Portal Hypertension
- Ascites
- Hypersplenism (with or without splenomegally)
- Varices (lower oesophageal and rectal)
- Synthetic Dysfunction
- Hepatopulmonary Syndrome
- Hepatorenal Syndrome
- Encephalopathy
- Hepatocellular Carcinoma (also called hepatoma)
Signs associated with the diagnosis
Signs of Chronic Liver Disease can be divided into those that are associated with the diagnosis of chronic liver disease, associated with decompensation and associated with the aetiology.
- Clubbing
- Palmar Erythema
- Spider Nevi (angiomata)
- Scratch marks
- Gynaecomastia
- Feminising Hair Distribution
- Testicular Atrophy
- Small irregular shrunken liver
- Anaemia
- Distended abdominal veins
- Caput madusae (recanalisation of the umbilical vein)
Signs associated with decompensation
- Drowsiness (encephalopathy)
- Hyperventilation (encephalopathy)
- Metabolic Flap/Asterixis (encephalopathy)
- Jaundice (excretory dysfunction)
- Ascites (portal hypertension and hypoalbuminaemia)
- Leukonychia (hypoalbuminaemia)
- Peripheral Oedema (hypoalbuminaemia)
- Bruising (coagulopathy)
Signs associated with the aetiology
- Dupuytren's contracture (Alcohol)
- Parotidomegally (Alcohol)
- Peripheral neuropathy (Alcohol and some drugs)
- Cerebellar signs (alcohol and Wilson's disease)
- Hepatomegally (alcohol, NAFLD, Haemochromatosis)
- Kaiser-Fleisher Rings (Wilson's)
- Increased pigmentation of the skin (Haemochromatosis)
- Signs of Right Heart Failure
- Tattoos (Hepatitis C)
Note that other diseases can involve the liver and even cause hepatomegaly but would not be considered part of the spectrum of chronic liver disease. Some examples of this would include chronic cancers with liver metastases, infiltrative haematological disorders such as chronic lymphoproliferative conditions, chronic myeloid leukaemias, myelofibrosis and metabolic abnormalities such as Gaucher's and Glycogen Storage Diseases.
Assessment
References
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