Chronic liver disease

Question 1

What is the definition of chronic liver disease?

Answer 1

Progressive destruction and regeneration of the liver, leading to fibrosis and cirrhosis

Question 2

How common is chronic liver disease?

Answer 2

Admission to hospital and liver deaths is between 8-10% a year. It is the 5th most common cause of death in the UK

Question 3

What is the pathology of chronic liver disease?

Answer 3

• Liver damage via inflammation → cirrhosis (end stage)
• Portal vein blood bypasses sinusoids = 1st pass metabolism does not occur
• Portal hypertension
Micronodular = small nodules - normally caused by alcohol and biliary disease
Macronodular = variable sizes - normally caused by chronic viral hepatitis

Question 4

What are the risk factors/aetiology of chronic liver disease?

Answer 4

• Alcohol
• Hepatitis B/C
• Genetic disorders: Haemochromatosis, a1-antitripsin deficiency, Wilson’s disease
• Non alcoholic steatohepatitis
• Autoimmune: primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis
• Drugs: amiodarone, methyldopa, methotrexate

Question 5

What are the signs and symptoms of chronic liver disease?

Answer 5

•	↑ LFTs
•	Leuconychia – white nails from hypoalbuminaemia
•	Jaudice
•	Clubbing
•	Palmar erythema
•	Dupuytren’s contracture
•	Spider naevi
•	Kayser-Fleisher rings - Wilson's disease
•	Gynecomastia
•	Itching skin
•	Loss of body hair
•	Astrixes
•	Hepatomegaly 
•	Ascites/peripheral oedema
Enceohalopathy
Bruising
Oesophageal varices
Capet medusa

Question 6

What other diseases present similarly to chronic liver disease?

Answer 6

• Constrictive pericarditis
• Portal/splenic vein thrombosis
• IVC obstruction
• Schistosomiasis
• Sarcoidosis
• Nodular regenerative hyperplasia

Question 7

What investigations are required when chronic liver disease is suspected?

Answer 7

• ↑ bilirubin, AST, ALT, alk phos
• ↓ albumin, white blood cells, platelets, ↑ INR
• Liver US
• MRI
• Ascitic tap fluid microscopy
• Liver biopsy

Question 8

What are the surgical treatments for chronic liver disease?

Answer 8

• Liver transplant – only definitive treatment

Question 9

What are the pharmacological treatments for chronic liver disease?

Answer 9

• Avoid NSAIDs, sedatives, opiates
• Colestyramine – for pruritus
• Spirolactone – for ascites

Question 10

What are the non pharmacological treatments for chronic liver disease?

Answer 10

• Good nutrition – supplements if required
• Alcohol abstinence
• Fluid restriction – for ascites