Numerous signs and symptoms can be observed in patients with chronic liver disease (CLD) [1]:

• Fatigue - is considered as the most common symptom regardless of the underlying cause [2]. Fatigue may be severely debilitating for some patients, such as those suffering from primary biliary cirrhosis (PBC) or viral hepatitis [2]. Moreover, fatigue is strongly associated with sleep disturbances and autonomic dysfunction, mainly in the form of reduced blood pressure regulation [3].
• Cutaneous changes - Jaundice is a predominant manifestation of cirrhosis, viral hepatitis, and several other liver-related pathologies, while spider nevi, caput medusae, palmar erythema and white nails are also important cutaneous findings [3].
• Ascites - accumulation of fluid in the peritoneum can be a sign of portal hypertension, hypoalbuminemia or other metabolic changes in the liver.
• Insulin resistance - Through mechanisms that are yet to be defined, hyperinsulinemia and development of diabetes mellitus type II can occur, most frequently in hepatocellular carcinoma and chronic viral hepatitis C [4].
• Coagulation abnormalities - The liver is the site of production of virtually all coagulation factors, making thrombocytopenia and an increased tendency for bleeding an important sign of the disease, especially in hepatitis C, interferon-induced injury, and portal hypertension [5].
• Kidney disease - Membranoproliferative glomerulonephritis (MPGN), membranous nephropathy, mixed cryoglobulinemia and polyarteritis nodosa (PAN) have all been identified in patients with chronic liver disease (particularly viral hepatitis) [6].

Cognitive symptoms, various neurological deficits, as well as pulmonary symptoms (most commonly as a result of impaired portal circulation), can also occur in CLD [1] [7].

• Anemia

  We present a 21-year-old male patient diagnosed with sickle cell anemia who developed chronic liver disease, together with a review of the literature. [ncbi.nlm.nih.gov]

  Iron deficiency, vitamin B12 and folate deficiency anemia (often seen in alcoholism or malnutrition), and anemia of chronic disease are other common causes of anemia. [clinical.diabetesjournals.org]

• Congestive Heart Failure

  We analyzed data from a large, diverse health care system to compare time trends in CLD-related hospitalizations with those in congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). [ncbi.nlm.nih.gov]

  heart failure: jugular venous distention, right pleural effusion, S3 gallop Cardiac cirrhosis Gynecomastia, testicular atrophy Cirrhosis Peripheral edema, signs of ascites, hepatosplenomegaly, caput medusa Cirrhosis Arterial bruit heard over the liver [medscape.com]

  heart failure hemochromatosis Wilson's disease autoimmune diseases sarcoidosis Bud-Chiari syndrome a1-AT deficiency idiopathic return to top Pathophysiology Acute injury can lead to chronic inflammation and hepatocyte death, associated with lymphocyte [sharinginhealth.com]

  Cardiovascular drug therapy in patients with hepatic diseases and patients with congestive heart failure. J Clin Pharmacol 2000;40:11-30. Ge PS, Runyon BA. The changing role of beta-blocker therapy in patients with cirrhosis. [sapd.es]

  Congestive heart failure or tricuspid regurgitation (although this is rarely seen now due to improved management). Infections including congenital and tertiary syphilis and schistosomiasis [ 2 ]. [patient.info]

• Heart Failure

  We analyzed data from a large, diverse health care system to compare time trends in CLD-related hospitalizations with those in congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). [ncbi.nlm.nih.gov]

  Cirrhosis Xanthomata, xanthelasma Primary biliary cirrhosis Obesity, increased waist circumference [13] Nonalcoholic fatty liver disease Kayser-Fleischer corneal rings Wilson's disease Parotid enlargement Alcoholic liver disease Signs of congestive heart [medscape.com]

  Metabolic Non-alcoholic fatty liver disease Haemochromatosis Wilson’s diseaseAutoimmune response causes Primary biliary cholangitis (previously known as primary biliary cirrhosis) Primary sclerosing cholangitis Autoimmune HepatitisOther Right heart failure [en.wikipedia.org]

  […] iron absorption leading to iron deposition in the liver and other organs HFE gene on chromosome 6 – variable penetrance Carrier prevalence 1 in 10 in northern Europe Leads to liver cirrhosis, diabetes, skin discolouration, hypogonadism, arrhythmias, heart [oxfordmedicaleducation.com]

  Congenital / hereditary – biliary atresia Heart failure 5. Autoimmune – usually female Portal HTN – varices 6. Cryptogenic Portal vein thrombosisDiagnosing CLD – based on: 1. [slideshare.net]

• Vascular Disease

  e.g. primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC) : 5-10% metabolic disease, e.g. hereditary hemochromatosis, Wilson disease, alpha-1-antitrypsin deficiency : 5% autoimmune hepatitis vascular disease, e.g. congestive hepatopathy [radiopaedia.org]

  Glomerular filtration pressure is dependent on afferent and efferent vascular tone. [ccforum.biomedcentral.com]

  We will not evaluate your acute encephalopathy under 5.05F if it results from conditions other than chronic liver disease, such as vascular events and neoplastic diseases. [ssa.gov]

• Arthritis

  Autoimmunity is very common in CVID, occurring in approximately 25% of the patients particularly with autoimmune thrombocytopenia, hemolytic anemia, inflammatory bowel disease, and rheumatoid arthritis. [ncbi.nlm.nih.gov]

  FastStats Homepage Diseases and Conditions Anemia or Iron Deficiency Arthritis and Bone Arthritis Osteoporosis Cancer Cardiovascular Cerebrovascular Disease or Stroke Cholesterol Heart Disease Hypertension Dementia and Mental Health Alzheimer’s Disease [cdc.gov]

  Table 2 Disease associations seen in autoimmune hepatitis Conditions seen in younger AIH subjects Conditions seen in the over 65 year olds Rheumatoid arthritis Rheumatoid arthritis Autoimmune thyroid disease Autoimmune thyroid disease Ulcerative colitis [ageing.oxfordjournals.org]

  […] hepatobiliary disease (for example, gallstones, primary sclerosing cholangitis); urologic disease (for example, kidney stones, obstructive hydronephrosis); skin involvement (for example, erythema nodosum, pyoderma gangrenosum); or non-destructive inflammatory arthritis [ssa.gov]

• Alopecia

  >5 in area of Paracentesis Microscopy, C/S, amylase Gynaecomastia drainage of SVC Malignant cells, infections (SBP), pancreatitisHead Jaundice Parotid enlargement – EtOH liver Hepatitis serology Cause of CLD Pallor dz Other causes of Autoantibodies Alopecia [slideshare.net]

  Otospondylomegaepiphyseal dysplasia (Hyperlordosis, Lumbar hyperlordosis) Pfeiffer syndrome (Hyperlordosis) Pinheiro Freire-Maia Miranda syndrome (Hyperlordosis) Potassium-aggravated myotonia (Hyperlordosis) Primary hypergonadotropic hypogonadism-partial alopecia [144.217.79.236]

• Irritability

  Dedicated to Helping You Whole-Person Digestive Care At AdventHealth Celebration, formerly Florida Hospital Celebration Health, our gastroenterology experts have the skill and technologies to treat a variety of digestive problems — from simple heartburn to irritable [floridahospital.com]

  Test for orientation to TPP ProceduralEncephalopathy 4 stages of encephalopathy Paracentesis – diagnostic & therapeutic (SOB) Stage I: sleep-wake reversal, slurred speech, slow mentation If leucocyte count >250cells/mm3, give fluoroquinolone Stage II: irritability [slideshare.net]

  Medications may irritate the liver blood vessels causing narrowing or the formation of blood clots (thrombosis). Birth control pills may cause hepatic vein thrombosis, especially in smokers. [medicinenet.com]

• Stroke

  In clinical practice, this increased risk of bleeding has not been identified as a protective factor against stroke or systemic embolism associated with atrial fibrillation (AF). [ncbi.nlm.nih.gov]

  FastStats Homepage Diseases and Conditions Anemia or Iron Deficiency Arthritis and Bone Arthritis Osteoporosis Cancer Cardiovascular Cerebrovascular Disease or Stroke Cholesterol Heart Disease Hypertension Dementia and Mental Health Alzheimer’s Disease [cdc.gov]

  National Institute of Neurological Disorders and Stroke [On-line bilgiler]. http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm through http://www.ninds.nih.gov. (Güncelleştirilme tarihi: 25 Ocak 2006). [labtestsonline.org.tr]

  National Institute of Neurological Disorders and Stroke [On-line information]. Available online at http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm through http://www.ninds.nih.gov. (2006 January 25, Updated). [labtestsonline.org]

• Hyperactivity

  This disorder appears to be genetic in origin with an autosomal dominant inheritance and was characterized by hyperactivity of the immune system with increased activated cytotoxic T lymphocytes in peripheral blood and bone marrow and the presence of gamma-interferon [ncbi.nlm.nih.gov]

  Increased requirement for folate due to hyperactivity of the bone marrow secondary to gastrointestinal bleeding. hypersplenism, or hemolysis appeared to contribute to the development of abnormal folic acid determinations in many patients in both the alcoholic [bloodjournal.org]

  Diseases and Conditions Anemia or Iron Deficiency Arthritis and Bone Arthritis Osteoporosis Cancer Cardiovascular Cerebrovascular Disease or Stroke Cholesterol Heart Disease Hypertension Dementia and Mental Health Alzheimer’s Disease Attention Deficit Hyperactivity [cdc.gov]

• Slurred Speech

  speech, slow mentation If leucocyte count >250cells/mm3, give fluoroquinolone Stage II: irritability, asterixis, lethargy, disorientation, personality Δ 2. [slideshare.net]

  Other symptoms of cirrhosis include: anemia bleeding gums decreased interest in sex fever fluid in the lungs hallucinations lethargy lightheadedness muscle weakness musty breath painful nerve inflammation (neuritis) slurred speech tremors If the liver [medical-dictionary.thefreedictionary.com]

• Kidney Failure

  For unknown reasons, the kidneys malfunction in up to half of people with liver failure. Liver failure that leads to kidney failure is called hepatorenal syndrome. [merckmanuals.com]

  Other complications from cirrhosis include: bruising (due to low platelet count and/or poor clotting) bleeding (due to decreased clotting proteins) sensitivity to medications (the liver processes medications in the body) kidney failure liver cancer insulin [healthline.com]

  Hepatorenal syndrome: For unknown reasons, liver failure leads to kidney failure in some people. Often the progress toward liver failure is slow and gradual. Although cirrhosis has traditionally been linked with alcoholism, it has many causes. [emedicinehealth.com]

  Kidney disease or failure. Easy bruising and severe bleeding. This happens when the liver stops making proteins that are needed for your blood to clot. Type 2 diabetes. [urmc.rochester.edu]

An extensive diagnostic workup is necessary to establish the underlying cause and determine the severity of liver injury. Firstly, it is mandatory to obtain a detailed patient history that will include information about the onset of symptoms and existing hepatic or extrahepatic conditions that may be responsible for their appearance. Secondly, a meticulous physical examination can reveal key features of liver injury and aid in making a presumptive diagnosis. Initial laboratory workup should include a complete blood count (CBC) with a full coagulation panel, alanine and aspartate aminotransferases (ALT and AST, respectively), alkaline phosphatase (ALP), lipid profiles, bilirubin, gamma-glutamyl transferase (γGT), glucose levels and kidney function tests (blood urea nitrogen, creatinine and urinalysis). Carbohydrate-deficient transferrin (CDT) is used to detect heavy alcohol consumption, while Hepatitis B surface and envelope antigens (HBsAg and HBeAg, respectively), as well as anti-hepatitis C (anti-HCV) antibodies, form the mainstay of viral hepatitis workup [1]. If the cause cannot be identified,then autoantibodies (antinuclear, anti-neutrophil cytoplasmic antibodies, anti-liver kidney microsomal, and anti-soluble liver antigen, or ANA, ANCA, anti-LKM and anti-SLA), parameters of iron metabolism (ferritin, total iron binding capacity, transferrin) and ceruloplasmin with urinary copper (Cu) excretion should be evaluated [1]. In addition to laboratory studies, imaging procedures can play a vital role in assessing CLD. Doppler, contrast enhanced or standard ultrasonography may be highly useful [8], while magnetic resonance imaging (MRI) and computed tomography (CT) can also provide important clues regarding the etiology and pathogenesis. As a last resort, liver biopsy can be performed and is considered to be the optimal diagnostic modality for diagnosis of non-viral causes of CLD [1].

No treatment-related deaths were reported. [ncbi.nlm.nih.gov]

New Treatments in Chronic Liver Disease will provide an update on commonly encountered problems in the treatment of liver disease. [scripps.org]

It complicates the management and worsens the prognosis. Treatment options are costly and include platelet transfusion, splenectomy, splenic artery embolization, TIPPS and thrombopoietin (TPO) agonists. [ncbi.nlm.nih.gov]

The Child-Pugh score consists of five clinical features and is used to assess the prognosis of chronic liver disease and cirrhosis. 2. [2minutemedicine.com]

Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy. J. Crit. Care 2009; 24:364–370. Fernandez J, Navasa M, Gomez J et al. [sapd.es]

PIVKA-II correlated with tumour size independently of CLD-etiology (P< 0.001) and AFP in CHB patients only (P= 0.007). [ncbi.nlm.nih.gov]

KEYWORDS: Catha edulis; Epidemiology; Hepatotoxicity; Sub-Saharan Africa; Viral hepatitis [ncbi.nlm.nih.gov]

The epidemiological characteristics of each disease are presented in Table 1. [ageing.oxfordjournals.org]

This review addresses the different definitions developed by leading research groups, epidemiological and pathophysiological aspects, and the latest treatments for this entity. [dovepress.com]

The FDA’s approval is based on a reduction in the level of the biomarker alkaline phosphatase (ALP), as a surrogate endpoint which, based on multiple levels of evidence (mechanistic, clinical trial, epidemiologic), could be relied upon to be reasonably [fda.gov]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

In the past decade, rapid progress has been made in our understanding of the pathophysiology of liver fibrosis and a large number of potential cellular and molecular antifibrotic targets have been identified. [ncbi.nlm.nih.gov]

The “predisposition, infection/inflammation, response, organ failure” (PIRO) concept used to evaluate sepsis may be valuable when it is sought to describe the pathophysiology and clinical features of ACLF. [dbpia.co.kr]

The pathophysiology involves inflammatory processes associated with a trigger factor in susceptible individuals (related to altered immunity in the cirrhotic population). [dovepress.com]

The aim of this article is to: 1) Define chronic hepatitis and cirrhosis; 2) Review briefly the clinical presentation, pathophysiology, diagnosis, and management of the more common pediatric causes of chronic liver disease; 3) Review the complications [pedsinreview.aappublications.org]

He subsequently developed a fatal pulmonary embolism, which may not have occurred if he had been prescribed prophylactic anticoagulation to prevent venous thromboembolic disease. [ncbi.nlm.nih.gov]

Treatments focus on preventing further damage. Learn more about cirrhosis treatments, including liver transplant. [stanfordhealthcare.org]

[…] hepatocellular carcinoma and even clear the virus.13 Treatment can also contribute to disease prevention by reducing the reservoir of infected individuals who can transmit the virus. ar أيمكنك ان تخبرني كيف أصل إلى " برينت هود " ؟ en Viral hepatitis [ar.glosbe.com]

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7. Lammert F, Wilkens G, Dietrich CG, Geier A, Wasmuth HE, Matern S. Extrahepatic manifestations of chronic liver diseases [Article in German]. Versicherungsmedizin. 2005;57(2):64-71.
8. Gerstenmaier JF, Gibson RN. Ultrasound in chronic liver disease. Insights Imaging. 2014;5(4):441-455.