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 (chronic hepatitis), liver cirrhosis, and hepatocellular carcinoma. The entire spectrum need not be experienced. 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. Nail clubbing Palmar erythema Spider nevi (angiomata) Gynaecomastia Feminising hair distribution Testicular atrophy Small irregular shrunken liver Anaemia Caput medusae Drowsiness (encephalopathy) Hyperventilation (encephalopathy) Metabolic flap/asterixis (encephalopathy) Jaundice (excretory dysfunction) Ascites (portal hypertension and hypoalbuminemia) Leukonychia (hypoalbuminaemia) Peripheral oedema (hypoalbuminaemia) Bruising (coagulopathy) Acid-base imbalance, most commonly respiratory alkalosis Dupuytren's contracture (alcohol) Parotid enlargement (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 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.