Chronic Liver Disease
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Introduction
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Causes and Risk Factors
Chronic liver disease (occurring over 6 months) can be caused by many things, and it can be difficult to find the cause.
Chronic hepatitis follows acute hepatitis B in 5-10% of the time, and acute on chronic cases can occur.
Chronic hepatitis C occurs in up to 75% of people with infection.
Autoimmune liver disease most often occurs in young women and is characterized by many plasma cells, hypergammaglobulinemia, as well as anti-nuclear or anti-smooth muscle antibodies.
Nonalcoholic fatty liver disease most commonly occurs in people who are overweight, and have diabetes and hyperlipidemia.
alcohol, drugs, and toxins vitamin A |
viral hepatitis B or C
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fatty liver disease:
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Wilson's disease autoimmune diseases a1-AT deficiency
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Pathophysiology
Acute injury leads to mild chronic injury, which is usually associated with lymphocytes. Severe inflammation results in fibrosis with a certain pattern.
The grade of injury is determined by the numbers and location of inflammatory cells, while the stage of disease depends on degree, location, and distortion caused by fibrosis.
Compensated cirrhosis can lead to uncompensated cirrhosis, hepatocellular carcinoma, or death.
Portal hypertension can back up into the spleen, which enlarges and can sponge up platelets, causing thrombocytosis.
Signs and Symptoms
Liver damage is most often silent until 75% of the liver function is lost.
Decompensation results in ascites, jaundice, and encephalopathy.
Cirrhosis: fibrosis encircled with regenerative nodules.
Stages I-IV can be diagnosed histologically
Fatty liver disease can cause macrocytosis.
- history
- physical exam
History
anorexia
nausea
abdominal discomfort
Physical Exam
Jaundice is a clear sign of liver problems.
Ascites due to portal hypertension and transudation, hypoalbuminemia (low oncotic pressure)
hepatic encephalopathy: liver problems can affect neurotransmitters
asterixis, constructional apaxia, abnormal ECG
- asterixis is a problem with attention span: people lose focus on their hands, which then fall with gravity; people draw their hands back quickly.
esophageal/rectal varicies
gynecomastia
spider nevi
clubbing
palmar erythema
scant body hair
leukonicia
itchiness
Dupetrene's contractures
Kaput medusa
Autoimmune hepatitis can lead to amenorrhea, rashes, acne, vasculitis, thyroiditis, and Sjogren's syndrome.
Investigations
- lab investigations
- diagnostic imaging
- biopsy
Lab Investigations
serum transaminases are typcially elevated over 10x, while serum alkaline phosphatase is less than 3x normal.
prolonged prothrombin time, hypoalbuminemia, and unconjugated hyperbilirubinemia can occur.
Diagnostic Imaging
Imaging
Liver ultrasound - can be used to detect gallbladder and bile duct disease, including stones.(Stones move; polyps do not)
Biopsy
Liver biopsy can be very important for diagnosis and is good for diffuse disease, but not as much for patchy conditions.
The diagnosis of chronic hepatitis requires the presence of inflammatory cells, which can be accompanied by significant fibrous deposition, disruption of hepatic lobular architecture, and possible progression towards cirrhosis.
Differential Diagnosis
Treatments
Consequences and Course
Fulminant liver failure is a serious result of acute liver damage.
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Additional Resources
Medline Plus resources on liver diseases
Topic Development
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