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.
Numerous signs and symptoms can be observed in patients with chronic liver disease (CLD) :
Cognitive symptoms, various neurological deficits, as well as pulmonary symptoms (most commonly as a result of impaired portal circulation), can also occur in CLD  .
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 . 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 . 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 , 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 .