Chronic Liver Disease

Definition/diagnostic criteria Chronic liver disease (CLD) encompasses a spectrum of diseases that affect the liver over a long period, typically more than six months. It includes conditions such as cirrhosis, chronic hepatitis, and fatty liver disease. The diagnosis is often based on the combination of history, physical examination, and characteristic abnormalities in liver function tests, imaging, and sometimes liver biopsy results. According to NICE guidelines, the presence of persistent abnormalities in liver function tests (LFTs) for over six months necessitates further evaluation for CLD.

Epidemiology In the UK, CLD is a significant health concern, with rising incidence and mortality rates. The most common causes include alcohol-related liver disease, non-alcoholic fatty liver disease (NAFLD), and chronic viral hepatitis. The obesity epidemic has resulted in making NAFLDt the most common liver disorder in Western countries.

Diagnosis

Clinical features: Early stages of CLD may be asymptomatic or present with non-specific symptoms such as fatigue and malaise. As the disease progresses, more specific signs such as jaundice, spider naevi, palmar erythema, and ascites may develop. A detailed history including alcohol consumption, medication use, and risk factors for viral hepatitis is crucial.

Investigations: Initial investigations include LFTs, which may show elevated transaminases, alkaline phosphatase, and bilirubin. Ultrasound of the liver is typically the first-line imaging modality, useful for assessing liver size, structure, and the presence of cirrhosis or fatty liver. FibroScan (transient elastography) is increasingly used for non-invasive assessment of liver fibrosis. In selected cases, liver biopsy remains the gold standard for diagnosing the specific type and stage of liver disease.

Treatment Management of CLD involves treating the underlying cause, preventing disease progression, and managing complications. Lifestyle modifications, including alcohol cessation and weight loss in NAFLD, are fundamental. Pharmacological treatments vary by etiology; for example, antiviral medications for chronic viral hepatitis and corticosteroids for autoimmune hepatitis. Complications such as variceal bleeding, ascites, and hepatic encephalopathy require specific interventions. Liver transplantation may be considered in end-stage liver disease.

Prognosis The prognosis of CLD is highly variable, depending on the cause, stage at diagnosis, and presence of liver cirrhosis. Early diagnosis and intervention can significantly improve outcomes. The development of cirrhosis is associated with a higher risk of liver failure and hepatocellular carcinoma, markedly affecting survival rates. Regular monitoring and management of complications are crucial for improving quality of life and survival.