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Chronic Liver Disease

Hepatic: Chronic

Chronic liver disease can arise from viral, autoimmune, iatrogenic, or neoplastic disorders, manifesting with a myriad of hepatic and extrahepatic symptoms. An extensive workup is necessary to assess the severity of liver injury and the underlying cause.


Presentation

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

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]
  • 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]
  • The medication was discontinued in four patients because of progression of primary disease, high cost, oral dryness, and anemia. No significant toxicity was observed on the serum biochemical analyses.[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]
Splenectomy
  • The long survival of the patients in this study may have been due to early splenectomy.[ncbi.nlm.nih.gov]
Myelopathy
  • Abstract Hepatic myelopathy is a rare neurological complication of chronic liver disease, which is usually seen in adults, presenting as pure motor spastic paraparesis.[ncbi.nlm.nih.gov]
Dystonia
  • We describe an 8-year-old girl with chronic hepatic failure and dystonia in association with an elevated whole blood manganese level and symmetric hyperintense pallidal lesions on magnetic resonance imaging.[ncbi.nlm.nih.gov]

Workup

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].

Sarcoptes Scabiei
  • Abstract Crusted scabies is a less common variant of scabies that is highly contagious, difficult to treat and involves infestation by Sarcoptes scabiei var. hominis.[ncbi.nlm.nih.gov]

Treatment

  • No treatment-related deaths were reported.[ncbi.nlm.nih.gov]
  • In chronic hepatitis B (CHB) patients, fibrosis assessment during antiviral treatment is a key step in the clinical management.[ncbi.nlm.nih.gov]
  • However, the mechanism by which this treatment caused the regression of intrapulmonary shunt is unknown.[ncbi.nlm.nih.gov]
  • Liver transplantation is an effective treatment for end-stage liver disease; however, demand greatly outweighs donor organ supply, and in many parts of the world liver transplantation is unavailable.[ncbi.nlm.nih.gov]
  • On this treatment he has so far remained well for two years.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: Manipulation of the gut microbiota with diet, probiotics or faecal microbiota transplantation to promote the growth of "healthy" bacteria may ameliorate the dysbiosis and alter prognosis. 2017 John Wiley & Sons Ltd.[ncbi.nlm.nih.gov]
  • This study investigated the effects of the presence of type 2 diabetes mellitus (T2D) and/or chronic liver disease (CLD) on the incidence and prognosis of dementia during a 10-year period in Korea using a nationwide population-based dataset from the Korea[ncbi.nlm.nih.gov]
  • Abstract The presence of significant fibrosis is an indicator for liver disease staging and prognosis.[ncbi.nlm.nih.gov]
  • In addition to being an indicator of advanced disease and poor prognosis, it frequently prevents crucial interventions.[dovepress.com]
  • […] of disease Can be used for staging prior to consideration of liver transplantation Liver transplantation Complications of chronic liver disease (CLD) Variceal bleeding Ascites Spontaneous bacterial peritonitis Encephalopathy Hepatorenal syndrome HCC Prognosis[oxfordmedicaleducation.com]

Etiology

  • 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]
  • BACKGROUND: An etiologically important role has been suggested for hepatitis C virus (HCV) infection in the development of B-cell non-Hodgkin's lymphoma (NHL).[ncbi.nlm.nih.gov]
  • NAFLD was the most common etiology accounting for 22% of all CLD in the later period. The prevalence of ALD has been steadily increasing throughout the years, while HCV has been decreasing.[ncbi.nlm.nih.gov]
  • BACKGROUND & AIMS: Although treatment of hepatitis C virus (HCV) infection has improved, the prevalence of alcoholic liver disease (ALD) has been increasing, so we need an updated estimate of the burden and etiology-specific mortality of chronic liver[ncbi.nlm.nih.gov]
  • Although all metabolic and structural abnormalities should be excluded in patients with hepatic encephalopathy, if the etiology remains in question, the possibility of increased intracranial pressure should be considered in patients with chronic liver[ncbi.nlm.nih.gov]

Epidemiology

  • 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]
  • 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]
  • Definition of chronic liver disease (CLD) Progressive destruction of the liver parenchyma over a period greater than 6 months leading to fibrosis and cirrhosis Epidemiology of chronic liver disease (CLD) Literature on the incidence and prevalence of liver[oxfordmedicaleducation.com]
Sex distribution
Age distribution

Pathophysiology

  • 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 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]
  • An in-depth understanding of the complex pathophysiology of the thrombocytopenia of CLD is crucial when considering treatment strategies. This review outlines the recent advances in our understanding of thrombocytopenia in cirrhosis and CLD.[dovepress.com]
  • In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. . Accessed Dec. 20, 2016. Milic S, et al.[mayoclinic.com]
  • The pathophysiology involves inflammatory processes associated with a trigger factor in susceptible individuals (related to altered immunity in the cirrhotic population).[dovepress.com]

Prevention

  • 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]
  • However, newer evidence from pre-clinical and clinical research has shown that statins are drugs with a potentially beneficial impact on the natural history of cirrhosis, on portal hypertension, and in HCC prevention.[ncbi.nlm.nih.gov]
  • Chenodeoxycholic acid 125 mg twice daily for two months, and then 125 mg daily, cured his jaundice and pruritus, returned his transaminase activities to normal, and eliminated the need for calcitriol for prevention of rickets.[ncbi.nlm.nih.gov]
  • BACKGROUND: It is important to be aware of oral and dental problems in the early period in children with chronic liver disease (CLD) to prevent late complications.[ncbi.nlm.nih.gov]
  • For stable patients whose acute variceal bleed is controlled, TIPS is equal to combined beta-blocker and band ligation in the prevention of recurrent variceal bleed.[ncbi.nlm.nih.gov]

References

Article

  1. Schuppan D, Afdhal NH. Liver Cirrhosis. Lancet. 2008;371(9615):838-851.
  2. Swain MG. Fatigue in liver disease: Pathophysiology and clinical management. Can J Gastroenterol. 2006;20(3):181-188.
  3. Newton JL, Jones DE. Managing systemic symptoms in chronic liver disease. J Hepatol. 2012;56(1):S46-55.
  4. Kawaguchi T, Taniguchi E, Itou M, Sakata M, Sumie S, Sata M. Insulin resistance and chronic liver disease. World J Hepatol. 2011;3(5):99-107.
  5. Poordad F. Review article: thrombocytopenia in chronic liver disease. Aliment Pharmacol Ther. 2007;26(1):5-11.
  6. Hrstić I, Ostojić R. Chronic liver diseases in patients with chronic kidney disease [Article in Croatian]. Acta Med Croatica. 2011;65(4):349-353.
  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.

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Last updated: 2018-06-22 01:30