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) :
- Fatigue - is considered as the most common symptom regardless of the underlying cause . Fatigue may be severely debilitating for some patients, such as those suffering from primary biliary cirrhosis (PBC) or viral hepatitis . Moreover, fatigue is strongly associated with sleep disturbances and autonomic dysfunction, mainly in the form of reduced blood pressure regulation .
- 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 .
- 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 .
- 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 .
- 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) .
Entire Body System
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]
>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 [22.214.171.124]
- 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. [hopkinsmedicine.org]
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 .
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]
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]
He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.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]
This review addresses the different definitions developed by leading research groups, epidemiological and pathophysiological aspects, and the latest treatments for this entity. [dovepress.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]
[…] 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]
Treatments focus on preventing further damage. Learn more about cirrhosis treatments, including liver transplant. [stanfordhealthcare.org]
- Schuppan D, Afdhal NH. Liver Cirrhosis. Lancet. 2008;371(9615):838-851.
- Swain MG. Fatigue in liver disease: Pathophysiology and clinical management. Can J Gastroenterol. 2006;20(3):181-188.
- Newton JL, Jones DE. Managing systemic symptoms in chronic liver disease. J Hepatol. 2012;56(1):S46-55.
- 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.
- Poordad F. Review article: thrombocytopenia in chronic liver disease. Aliment Pharmacol Ther. 2007;26(1):5-11.
- Hrstić I, Ostojić R. Chronic liver diseases in patients with chronic kidney disease [Article in Croatian]. Acta Med Croatica. 2011;65(4):349-353.
- 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.
- Gerstenmaier JF, Gibson RN. Ultrasound in chronic liver disease. Insights Imaging. 2014;5(4):441-455.