Chronic Liver Disease
Function of the liver
- Metabolism of proteins, carbohydrate, fats and vitamins.
- Storage of glycogen, vitamins and minerals
- Detoxification and inactivation of endogenous and exogenous substances
- Secretion of bile
- Synthesis of coagulation factors.
Laboratory Evaluation
Liver (synthetic) function tests: PT/PTT, bilirubin, albumin
Inflammatory/injury tests (liver enzymes): AST/ALT
Full Blood Count (FBC) for platelet count and microcytosis
Serological investigations for viral hepatitis:
- Anti-HBs Ag (previous HBV infection or immunisation)
- IgM Anti-HBcAg - recent HBV infection
- IgM Anti-HAV - recent HAV infection
- Anti-HDV - previous delta virus infection
- Anti-HCV - chronic hepatitis C infection
- HCV-RNA - active HCV infection
Radiology: Abdominal ultrasound, CT scan - for lesions within the liver parenchyma, MRI - for lesions of the liver, biliary tree and pancreas
Endoscopy for gastroesophageal varices
Liver biopsy for the staging
Clinical Presentation:
- Signs of Cirrhosis: (signs of liver dysfunction) Jaundice, clubbing, palmer erythema, easy bruising, asterixis, spider nevi, gynecomastia, loss of body hair, testicular atrophy , encephalopathy.
- Signs of Portal Hypertension: splenomegaly, ascites, caput medusae (distended abdominal veins)
- Patients with CLD present with sarcopenia, frailty, fatigue, functional decline, hepatic osteodystrophy (osteoporosis and fracture) which are the target of physiotherapy program.
Causes of CLD:
- Chronic Viral Hepatitis: HCV, HBV end by cirrhosis and hepatocellular carcinoma
- Alcoholic Hepatitis
- Non-alcoholic fatty liver disease (NAFLD)
- Autoimmune hepatitis
- Drug-induced liver disease – e.g. methotrexate, alpha methyldopa, amiodarone
- Cryptogenic causes (18%)
