Chronic liver disease in the clinical context is a disease process of the liver

Liver

The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...

 that involves a process of progressive destruction and regeneration of the liver parenchyma

Parenchyma

Parenchyma is a term used to describe a bulk of a substance. It is used in different ways in animals and in plants.The term is New Latin, f. Greek παρέγχυμα - parenkhuma, "visceral flesh", f. παρεγχεῖν - parenkhein, "to pour in" f. para-, "beside" + en-, "in" + khein, "to pour"...

 leading to fibrosis

Fibrosis

Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...

 and cirrhosis

Cirrhosis

Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules , leading to loss of liver function...

.

Causes

The list of conditions associated with chronic liver disease is extensive and can be categorised in the following way:

Viral causes

• Hepatitis B
• Hepatitis C
  Hepatitis C
  Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
  
  
• Cytomegalovirus
  Cytomegalovirus
  Cytomegalovirus is a viral genus of the viral group known as Herpesviridae or herpesviruses. It is typically abbreviated as CMV: The species that infects humans is commonly known as human CMV or human herpesvirus-5 , and is the most studied of all cytomegaloviruses...
  
   (CMV)
• Epstein Barr Virus (EBV)

Toxic and drugs

• Alcoholic liver disease
  Alcoholic liver disease
  Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis. It is the major cause of liver disease in Western countries...
  
  
• Amiodarone
  Amiodarone
  Amiodarone is an antiarrhythmic agent used for various types of tachyarrhythmias , both ventricular and supraventricular arrhythmias. Discovered in 1961, it was not approved for use in the United States until 1985...
  
  
• Methotrexate
  Methotrexate
  Methotrexate , abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid. Methotrexate...
  
  
• Nitrofurantoin
  Nitrofurantoin
  Nitrofurantoin is an antibiotic which is marketed under the following brand names; Furadantin, Macrobid, Macrodantin, Nitrofur Mac, Nitro Macro, Nifty-SR, Martifur-MR, Martifur-100 , Urantoin, and Uvamin . It is usually used in treating urinary tract infection...
  
  

Metabolic

• Non-alcoholic fatty liver disease
  Non-alcoholic fatty liver disease
  Non-alcoholic fatty liver disease is one cause of a fatty liver, occurring when fat is deposited in the liver not due to excessive alcohol use. It is related to insulin resistance and the metabolic syndrome and may respond to treatments originally developed for other insulin-resistant states...
  
  
• Haemochromatosis
  Haemochromatosis
  Haemochromatosis type 1 is a hereditary disease characterized by excessive intestinal absorption of dietary iron resulting in a pathological increase in total body iron stores. Humans, like most animals, have no means to excrete excess iron...
  
  
• Wilson's Disease
  Wilson's disease
  Wilson's disease or hepatolenticular degeneration is an autosomal recessive genetic disorder in which copper accumulates in tissues; this manifests as neurological or psychiatric symptoms and liver disease...
  
  

Autoimmune

• Autoimmune Chronic Hepatitis
• Primary Biliary Cirrhosis
  Primary biliary cirrhosis
  Primary biliary cirrhosis, often abbreviated PBC, is an autoimmune disease of the liver marked by the slow progressive destruction of the small bile ducts within the liver. When these ducts are damaged, bile builds up in the liver and over time damages the tissue. This can lead to scarring,...
  
  
• Primary Sclerosing Cholangitis
  Primary sclerosing cholangitis
  Primary sclerosing cholangitis is a chronic liver disease caused by progressive inflammation and scarring of the bile ducts of the liver. The inflammation impedes the flow of bile to the gut, which can ultimately lead to liver cirrhosis, liver failure and liver cancer...
  
  

Other

• Right heart failure

Complications of chronic liver disease

• Portal Hypertension
  • Ascites
    Ascites
    Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis and severe liver...
    
    
  • Hypersplenism (with or without splenomegaly)
  • Lower oesophageal varices and rectal varices

• Synthetic Dysfunction
  • Hypoalbuminaemia
  • Coagulopathy
    Coagulopathy
    Coagulopathy is a condition in which the blood’s ability to clot is impaired. This condition can cause prolonged or excessive bleeding, which may occur spontaneously or following an injury or medical and dental procedures.The normal clotting process depends on the interplay of various proteins in...
    
    

• Hepatopulmonary Syndrome

• Hepatorenal Syndrome

• Encephalopathy

• Hepatocellular Carcinoma (also called hepatoma)

Signs associated with the diagnosis

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.

• Clubbing
• Palmar erythema
  Palmar erythema
  Palmar erythema is reddening of the palms at the thenar and hypothenar eminences.-Causes:It is associated with various physiological as well as pathological changes, the principal one of which is portal hypertension. It is also seen in patients with liver dysfunction, such as chronic liver disease...
  
  
• Spider nevi (angiomata)
• Scratch marks
• Gynaecomastia
• Feminising hair distribution
• Testicular atrophy
  Testicular atrophy
  Testicular atrophy is a medical condition in which the male reproductive organs diminish in size and may be accompanied by loss of function. This does not refer to temporary changes, such as those brought on by cold.Some medications can cause testicular atrophy...
  
  
• Small irregular shrunken liver
• Anaemia
• Caput medusae
  Caput medusae
  Caput medusae is the appearance of distended and engorged paraumbilical veins, which are seen radiating from the umbilicus across the abdomen to join systemic veins...
  
   (recanalisation of the umbilical vein) (Distended abdominal veins)

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
  Hyperventilation
  Hyperventilation or overbreathing is the state of breathing faster or deeper than normal, causing excessive expulsion of circulating carbon dioxide. It can result from a psychological state such as a panic attack, from a physiological condition such as metabolic acidosis, can be brought about by...
  
   (encephalopathy)
• Metabolic Flap/Asterixis (encephalopathy)
• Jaundice
  Jaundice
  Jaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae , and other mucous membranes caused by hyperbilirubinemia . This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid...
  
   (excretory dysfunction)
• Ascites
  Ascites
  Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis and severe liver...
  
   (portal hypertension and hypoalbuminaemia)
• Leukonychia
  Leukonychia
  Leukonychia , also known as white nails, is a medical term for white discoloration appearing on nails. It is derived from the Greek words leuko and onyx...
  
   (hypoalbuminaemia)
• Peripheral oedema (hypoalbuminaemia)
• Bruising (coagulopathy)

Signs associated with the aetiology

• Dupuytren's contracture
  Dupuytren's contracture
  Dupuytren's contracture , is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended...
  
   (Alcohol)
• Parotidomegally (Alcohol)
• Peripheral neuropathy
  Peripheral neuropathy
  Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of or trauma to the nerve or the side-effects of systemic illness....
  
   (Alcohol and some drugs)
• Cerebellar signs (alcohol and Wilson's disease)
• Hepatomegaly
  Hepatomegaly
  Hepatomegaly is the condition of having an enlarged liver. It is a nonspecific medical sign having many causes, which can broadly be broken down into infection, direct toxicity, hepatic tumours, or metabolic disorder. Often, hepatomegaly will present as an abdominal mass...
  
   (alcohol, NAFLD, Haemochromatosis)
• Kayser-Fleisher Rings (Wilson's)
• Increased pigmentation of the skin (Haemochromatosis)
• Signs of Right Heart Failure
• Tattoos (Hepatitis C)

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 and Glycogen Storage Diseases.

Risk Factors

• Health care professionals who are exposed to body fluids and infected blood
• Individuals who get multiple tattoos and body piercing
  Body piercing
  Body piercing, a form of body modification, is the practice of puncturing or cutting a part of the human body, creating an opening in which jewelry may be worn. The word piercing can refer to the act or practice of body piercing, or to an opening in the body created by this act or practice...
  
  
• Certain prescription medications
• Excessive alcohol use
• Having high levels of fat
  Fat
  Fats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...
  
   in the blood
• Sharing infected needle and syringes
• Obesity
• Having unprotected sex and multiple sex partners
• Working with toxic chemicals without wearing safety clothes

Treatment

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 .

Alternative Care

Because many chronic liver disorders have no cure, many people have been turning to alternative health care. Herbal supplements

Herbalism

Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, herblore, and phytotherapy...

 are widely used by many people with chronic liver disease . The herbs most frequently sought are black cohosh, ma huang, chaparral, comfrey

Comfrey

Comfrey is an important herb in organic gardening. It is used as a fertilizer and also has many purported medicinal uses...

, germander, greater celandine

Greater celandine

Chelidonium majus is a herbaceous perennial plant, the only species in the genus Chelidonium...

, kava

Kava

Kava or kava-kava is a crop of the western Pacific....

, mistletoe

Mistletoe

Mistletoe is the common name for obligate hemi-parasitic plants in several families in the order Santalales. The plants in question grow attached to and within the branches of a tree or shrub.-Mistletoe in the genus Viscum:...

, pennyroyal

Pennyroyal

Pennyroyal refers to two plants in the mint family, Lamiaceae. For the American species, see American pennyroyal. The European pennyroyal, Mentha pulegium, , is a plant in the mint genus, within the family Lamiaceae. Crushed Pennyroyal leaves exhibit a very strong fragrance similar to spearmint...

, skull cap

Scutellaria

Scutellaria is a genus of flowering plants in the mint family, Lamiaceae. It contains about 300 species, which are commonly known as skullcaps...

 and valerian

Valerian (herb)

Valerian is a hardy perennial flowering plant, with heads of sweetly scented pink or white flowers which bloom in the summer months. Valerian flower extracts were used as a perfume in the sixteenth century....

. 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. With liver disease, you only get one chance at life and that balance can easily be overturned by a toxic herb .

Prevention

Some chronic liver diseases cannot be prevented but one can reduce the risk by adopting the following measures:

• Do not drink excessive alcohol. Alcohol is one of the most common causes of chronic liver disease
  Alcoholic liver disease
  Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis. It is the major cause of liver disease in Western countries...
  
   in North America.

• Avoid high risk behaviour. If you do use intravenous drugs, do not share needles or syringes. Never have sex without a condom with a stranger and avoid multiple sex partners. If you plan to have tattoos or have your body pierced, choose a place which has a reputation for cleanliness and safety.

• Get vaccinated against hepatitis A and B. it is highly recommended that one get vaccinated against hepatitis B. This chronic infection
  Infection
  An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
  
   is highly contagious and one of the complications is liver cancer.

• Do not use multiple medications or illicit drugs unwisely. Never mix alcohol with medications. Always talk to your physician about your medications and get your liver enzymes checked to make sure that the liver is functioning fine.

• If you have any member of the family of friend who is sick, avoid contact with blood or bodily fluids. Many infections can be transferred through body fluids include HIV, hepatitis and even herpes. Do not make it a habit of sharing personal care products with anyone, even household members.

• If you work in an environment where there are chemicals, wear a mask. Take protective measures when spraying weed killers, insecticides or using other toxic chemicals. If you work with hazardous chemicals, change clothes before you go home. If you work in the garden and use chemicals, wear long sleeve shirts, gloves and a hat.

• Eat healthy exercise and keep your weight down. Obesity is a well known cause of chronic fatty liver disease .