Chronic liver disease

Chronic liver disease Microchapters
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Overview
Pathophysiology
Causes
Differentiating Chronic liver disease from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
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Echocardiography or Ultrasound
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Chronic liver disease is a liver disease of slow process and persisting over a long period of time, resulting in a progressive destruction of the liver.

Causes

Common Causes

• Cirrhosis
• Alcoholic liver disease
• Hepatitis C
• Hepatitis B
• Autoimmune hepatitis
• Portal hypertension
• Hemochromatosis
• Wilson's disease
• Gaucher disease
• Hepatoma
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Sarcoidosis
• Zellweger syndrome

Causes by Organ System

Cardiovascular	Right heart failure
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Methotrexate, Nitrofurantoin
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Autoimmune hepatitis, Cirrhosis, Hepatitis B , Hepatitis C, Hepatoma, Non-alcoholic fatty liver disease, Portal hypertension, Primary biliary cirrhosis , Primary sclerosing cholangitis, Sarcoidosis, Wilson's disease
Genetic	Gaucher disease, Hemochromatosis, Sarcoidosis, Wilson's disease, Zellweger syndrome
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Cytomegalovirus (CMV), Epstein Barr virus (EBV), Hepatitis B , Hepatitis C
Musculoskeletal / Ortho	No underlying causes
Neurologic	Wilson's disease
Nutritional / Metabolic	Gaucher disease, Hemochromatosis, Zellweger syndrome
Obstetric/Gynecologic	No underlying causes
Oncologic	Hepatoma
Opthalmologic	Wilson's disease
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Sarcoidosis
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Autoimmune hepatitis, Primary biliary cirrhosis , Primary sclerosing cholangitis, Sarcoidosis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcoholic liver disease

Causes in Alphabetical Order

• Alcoholic liver disease
• Autoimmune hepatitis
• Cirrhosis
• Cytomegalovirus (CMV)
• Epstein Barr virus (EBV)
• Gaucher disease
• Hemochromatosis
• Hepatitis B
• Hepatitis C
• Hepatoma
• Metabolic
• Methotrexate
• Nitrofurantoin
• Non-alcoholic fatty liver disease
• Portal hypertension
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Right heart failure
• Sarcoidosis
• Wilson's disease
• Zellweger syndrome

Risk Factors

• Health care professionals who are exposed to body fluids and infected blood

• Individuals who get multiple tattoos and body piercing

• Certain prescription medications

• Excessive alcohol use

• Having high levels of fat in the blood

• Sharing infected needle and syringes

• Obesity

• Having unprotected sex and multiple sex partners

• Working with toxic chemicals without wearing safety clothes

Natural History, Complications, Prognosis

Complications

• Portal hypertension
• Hypoalbuminaemia
• Coagulopathy
• Hepatopulmonary syndrome
• Hepatorenal syndrome
• Encephalopathy
• Hepatocellular carcinoma (also called hepatoma)

Prognosis

Prognosis is assessed by

• Model for End-Stage Liver Disease

• Child-Pugh score

Diagnosis

Physical examination

Skin

• Increased pigmentation of the skin
• Tattoos
• Scratch marks

Eyes

• Kayser-Fleischer ring

• Jaundice

Heart

• Signs of right heart failure

Lungs

• Hyperventilation

Abdomen

• Hepatomegaly
• Ascites
• Spider nevi (angiomata)

• Caput medusae

Extremities

• Dupuytren's contracture

• Leukonychia

• Peripheral oedema
• Bruising

• Clubbing

• Palmar erythema

Neurologic

• Peripheral neuropathy
• Cerebellar signs

• Asterixis

• Drowsiness

Other

• Parotidomegally
• Gynaecomastia
• Feminising hair distribution
• Testicular atrophy
• Anaemia

Treatment

The treatment of chronic liver disease depends on the cause. While some conditions may be treated with medications, others may require surgery or a transplant. Transplant is required when the liver fails and there is no other alternative . Because many chronic liver disorders have no cure, many people have been turning to alternative health care. Herbal supplements are widely used by many people with chronic liver disease. None of these herbs have ever been tested in randomized clinical trials and no one knows whether they work. Some common herbs known to be potentially harmful in liver disease include black cohosh, ma huang, chaparral, comfrey, germander, greater celandine, kava, mistletoe, pennyroyal, skull cap and valerian.

Prevention

Some chronic liver diseases cannot be prevented but one can reduce the risk by adopting the following measures:

• Do not drink excessive alcohol. Alcohol is one of the most common causes of chronic liver disease in North America.
• Avoid high risk behaviour. If you do use intravenous drugs, do not share needles or syringes. Never have sex without a condom with a stranger and avoid multiple sex partners. If you plan to have tattoos or have your body pierced, choose a place which has a reputation for cleanliness and safety.
• Get vaccinated against epatitis A and B. it is highly recommended that one get vaccinated against hepatitis B. This chronic infection is highly contagious and one of the complications is liver cancer.
• Do not use multiple medications or illicit drugs unwisely. Never mix alcohol with medications. Always talk to your physician about your medications and get your liver enzymes checked to make sure that the liver is functioning fine.
• If you have any member of the family of friend who is sick, avoid contact with blood or bodily fluids. Many infections can be transferred through body fluids include HIV, hepatitis and even herpes. Do not make it a habit of sharing personal care products with anyone, even household members.
• If you work in an environment where there are chemicals, wear a mask. Take protective measures when spraying weed killers, insecticides or using other toxic chemicals. If you work with hazardous chemicals, change clothes before you go home. If you work in the garden and use chemicals, wear long sleeve shirts, gloves and a hat.
• Eat healthy exercise and keep your weight down. Obesity is a well known cause of chronic fatty liver disease .

Related Chapters

• Hepato-biliary diseases

References

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