Chronic liver disease
||This article needs attention from an expert in Medicine. (June 2009)|
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 had lasted over a period of 6 months. It consists of a wide range of liver pathologies which include inflammation (chronic hepatitis), liver cirrhosis, and hepatocellular carcinoma. The entire spectrum need not be experienced.
The list of conditions associated with chronic liver disease is extensive and can be categorised in the following way:
Toxic and drugs
Complications of chronic liver disease
- Portal Hypertension
- Encephalopathy Kidat's disease
- Hepatocellular Carcinoma
Signs of chronic liver disease can be divided into those that are associated with the diagnosis of chronic liver disease, associated with decompensation and associated with the aetiology.
- Palmar erythema
- Spider nevi (angiomata)
- Feminising hair distribution
- Testicular atrophy
- Small irregular shrunken liver
- Caput medusae
It may be noted here that the chronic liver disease takes several years to develop.
Testing for chronic liver disease involves blood tests, x-rays and a biopsy of the liver. The liver biopsy is a simple procedure done with a fine thin needle under local anesthesia. The tissue sample is sent to a laboratory where it is examined underneath a microscope.
Signs associated with decompensation
- Drowsiness (encephalopathy)
- Hyperventilation (encephalopathy)
- Metabolic Flap/Asterixis (encephalopathy)
- Jaundice (excretory dysfunction)
- Ascites (portal hypertension and hypoalbuminaemia)
- Leukonychia (hypoalbuminaemia)
- Peripheral oedema (hypoalbuminaemia)
- Bruising (coagulopathy)
- Acid-base imbalance, most commonly respiratory alkalosis
Signs associated with the aetiology
- Dupuytren's contracture (Alcohol)
- Parotidomegally (Alcohol)
- Peripheral neuropathy (Alcohol and some drugs)
- Cerebellar signs (alcohol and Wilson's disease)
- Liver enlargement (alcohol, NAFLD, Haemochromatosis)
- Kayser-Fleisher Rings (Wilson's disease)
- Increased pigmentation of the skin (Haemochromatosis)
- Signs of Right Heart Failure
Note that other diseases can involve the liver and even 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.
- Health care professionals who are exposed to body fluids and infected blood
- Individuals who get multiple tattoos and body piercing
- Certain prescription medications
- Excessive alcohol use
- Having high levels of fat in the blood
- Sharing infected needle and syringes
- Having unprotected sex and multiple sex partners
- Working with toxic chemicals without wearing safety clothes
The treatment of chronic liver disease depends on the cause. While some conditions may be treated with medications, others may require surgery or a transplant. Transplant is required when the liver fails and there is no other alternative.
Because many chronic liver disorders have no cure, many people have been turning to alternative health care. Herbal supplements are widely used by many people with chronic liver disease. None of these herbs have ever been tested in randomized clinical trials and no one knows whether they work. So if you decide to use herbs for your chronic liver disease, read about the herb, know your disorder and talk to your physician. Some common herbs known to be potentially harmful in liver disease include black cohosh, ma huang, chaparral, comfrey, germander, greater celandine, kava, mistletoe, pennyroyal, skull cap and valerian. With liver disease, you only get one chance at life and that balance can easily be overturned by a toxic herb.