Chronic liver disease


Chronic liver disease in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. "Chronic liver disease" refers to disease of the liver which lasts over a period of six months. It consists of a wide range of liver pathologies which include inflammation, liver cirrhosis, and hepatocellular carcinoma. The entire spectrum need not be experienced.

Signs and symptoms

Signs of chronic liver disease detectable on clinical examination can be divided into those that are associated with the diagnosis of chronic liver disease, associated with decompensation, and associated with the cause.

Chronic liver disease

[Decompensation]

Signs associated with the cause

Note that other diseases can involve the liver and cause hepatomegaly but would not be considered part of the spectrum of chronic liver disease. Some examples of this would include chronic cancers with liver metastases, infiltrative haematological disorders such as chronic lymphoproliferative conditions, chronic myeloid leukaemias, myelofibrosis and metabolic abnormalities such as Gaucher's disease and glycogen storage diseases.

Complications

Portal hypertension

Causes

The list of conditions associated with chronic liver disease is extensive and can be categorised in the following way:
Viral causes
Cytomegalovirus, Epstein Barr virus, and yellow fever viruses cause acute hepatitis.
Toxic and drugs
Paracetamol causes acute liver damage.
Metabolic
Autoimmune response causes
Other

Risk factors

These differ according to the type of chronic liver disease.

Diagnosis

Chronic liver disease takes several years to develop and the condition may not be recognised unless there is clinical awareness of subtle signs and investigation of abnormal liver function tests.
Testing for chronic liver disease involves blood tests, imaging including ultrasound, and a biopsy of the liver. The liver biopsy is a simple procedure done with a fine thin needle under local anaesthesia. The tissue sample is sent to a laboratory where it is examined underneath a microscope.

Treatment

The treatment of chronic liver disease depends on the cause. Specific conditions may be treated with medications including corticosteroids, interferon, antivirals, bile acids or other drugs. Supportive therapy for complications of cirrhosis include diuretics, albumin, vitamin K, blood products, antibiotics and nutritional therapy. Other patients may require surgery or a transplant. Transplant is required when the liver fails and there is no other alternative.

Alternative medicine

Some studies indicate herbal remedies are useful, but there is not conclusive evidence to support their use. Some support may be found in the orthodox medical use of two of these in acute liver failure: N-acetyl cysteine is the treatment of choice for acetaminophen overdose; both NAC and milk-thistle or its derivative silibinin are used in liver poisoning from certain mushrooms, notably Amanita phalloides, although the use of milk-thistle is controversial. Some common herbs are known or suspected to be harmful to the liver, including black cohosh, ma huang, chaparral, comfrey, germander, greater celandine, kava, mistletoe, pennyroyal, skull cap and valerian.