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| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | {{Chronic liver disease}} |
| {{CMG}} ; {{AE}} {{ADI}} | | {{CMG}} ; {{AE}} {{ADI}} |
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| ==Overview== | | ==[[Chronic liver disease overview|Overview]]== |
| '''Chronic liver disease''' is a liver disease of slow process and persisting over a long period of time, resulting in a progressive destruction of the [[liver]].
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| ==Causes== | | ==[[Chronic liver disease pathophysiology|Pathophysiology]]== |
| ===Common Causes===
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| * [[Cirrhosis]]
| | ==[[Chronic liver disease causes|Causes]]== |
| * [[Alcoholic liver disease]]
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| * [[Hepatitis C]]
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| * [[Hepatitis B]]
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| * [[Autoimmune hepatitis]]
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| * [[Portal hypertension]]
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| * [[Hemochromatosis]]
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| * [[Wilson's disease]]
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| * [[Gaucher disease]]
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| * [[Hepatoma]]
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| * [[Primary biliary cirrhosis]]
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| * [[Primary sclerosing cholangitis]]
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| * [[Sarcoidosis]]
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| * [[Zellweger syndrome]]
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| ===Causes by Organ System===
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |}
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| | ==[[Chronic liver disease differential diagnosis|Differentiating Chronic liver disease from other Diseases]]== |
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| | ==[[Chronic liver disease epidemiology and demographics|Epidemiology and Demographics]]== |
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| ===Causes in Alphabetical Order=== | | ==[[Chronic liver disease risk factors|Risk Factors]]== |
| *[[Alcoholic liver disease]]
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| *[[Autoimmune hepatitis]]
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| *[[Cirrhosis]]
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| *[[Cytomegalovirus]] (CMV)
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| *[[Epstein Barr virus]] (EBV)
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| *[[Gaucher disease]]
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| *[[Hemochromatosis]]
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| *[[Hepatitis B]]
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| *[[Hepatitis C]]
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| *[[Hepatoma]]
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| *[[Metabolic]]
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| *[[Methotrexate]]
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| *[[Nitrofurantoin]]
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| *[[Non-alcoholic fatty liver disease]]
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| *[[Portal hypertension]]
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| *[[Primary biliary cirrhosis]]
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| *[[Primary sclerosing cholangitis]]
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| *[[Right heart failure]]
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| *[[Sarcoidosis]]
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| *[[Wilson's disease]]
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| *[[Zellweger syndrome]]
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| ==Risk Factors== | | ==[[Chronic liver disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| *Health care professionals who are exposed to [[body fluids]] and infected [[blood]]
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| *Individuals who get multiple tattoos and [[body piercing]]
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| *Certain prescription medications
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| *Excessive [[alcohol]] use
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| *Having high levels of [[fat]] in the blood
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| *Sharing infected needle and syringes
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| *[[Obesity]]
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| *Having unprotected sex and multiple sex partners
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| *Working with toxic chemicals without wearing safety clothes
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| == Natural History, Complications, Prognosis ==
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| '''Complications'''
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| * [[Portal hypertension]]
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| * [[Hypoalbuminaemia]]
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| * [[Coagulopathy]]
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| * [[Hepatopulmonary syndrome]]
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| * [[Hepatorenal syndrome]]
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| * [[Encephalopathy]]
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| * [[Hepatocellular carcinoma]] (also called [[hepatoma]])
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| '''Prognosis'''
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| Prognosis is assessed by
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| *[[Model for End-Stage Liver Disease]]
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| *[[Child-Pugh score]]
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| ==Diagnosis== | | ==Diagnosis== |
| ===Physical examination===
| | [[Chronic liver disease history and symptoms|History and Symptoms]] | [[Chronic liver disease physical examination|Physical Examination]] | [[Chronic liver disease laboratory findings|Laboratory Findings]] | [[Chronic liver disease CT|CT]] | [[Chronic liver disease MRI|MRI]] | [[Chronic liver disease echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Chronic liver disease other imaging findings|Other Imaging Findings]] | [[Chronic liver disease other diagnostic studies|Other Diagnostic Studies]] |
| ====Skin====
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| *Increased pigmentation of the skin
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| *Tattoos
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| *[[Scratch mark]]s
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| ==== Eyes ====
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| *[[Kayser-Fleischer ring]]
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| *[[Jaundice]]
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| ==== Heart ====
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| *Signs of [[right heart failure]]
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| ==== Lungs ====
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| *[[Hyperventilation]]
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| ==== Abdomen ====
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| *[[Hepatomegaly]]
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| *[[Ascites]]
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| *[[Spider nevi]] (angiomata)
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| *[[Caput medusae]]
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| ==== Extremities ====
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| *[[Dupuytren's contracture]]
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| *[[Leukonychia]]
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| *[[Peripheral oedema]]
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| *[[Bruising]]
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| *[[Clubbing]]
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| *[[Palmar erythema]]
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| ==== Neurologic ====
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| *[[Peripheral neuropathy]]
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| *Cerebellar signs
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| *[[Asterixis]]
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| *[[Drowsiness]]
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| ==== Other ====
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| *[[Parotid gland enlargement|Parotidomegally]]
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| *[[Gynaecomastia]]
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| *[[Feminising hair distribution]]
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| *[[Testicular atrophy]]
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| *[[Anaemia]]
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| ==Treatment== | | ==Treatment== |
| | [[Chronic liver disease medical therapy|Medical Therapy]] | [[Chronic liver disease surgery|Surgery]] | [[Chronic liver disease prevention|Prevention]] | [[Chronic liver disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Chronic liver disease future or investigational therapies|Future or Investigational Therapies]] |
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| The treatment of chronic liver disease depends on the cause. While some conditions may be treated with medications, others may require surgery or a [[Liver transplant|transplant]]. Transplant is required when the liver fails and there is no other alternative <ref>[http://www.gastro.com/Gastro/liverdisease.aspx Liver Disease] Gastro.com - 27/01/2007/</ref>.
| | ==Case Studies== |
| Because many chronic liver disorders have no cure, many people have been turning to alternative health care. [[Herbalism|Herbal supplements]] are widely used by many people with chronic liver disease {{Citation needed|date=May 2012}}. None of these herbs have ever been tested in randomized clinical trials and no one knows whether they work. Some common herbs known to be potentially harmful in liver disease include [[black cohosh]], [[ma huang]], [[Larrea tridentata|chaparral]], [[comfrey]], [[germander]], [[greater celandine]], [[kava]], [[mistletoe]], [[pennyroyal]], [[Scutellaria|skull cap]] and [[Valerian (herb)|valerian]].
| | [[Chronic liver disease case study one|Case #1]] |
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| == Prevention == | | ==Related Chapters== |
| | * [[Hepato-biliary diseases]] |
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| Some chronic liver diseases cannot be prevented but one can reduce the risk by adopting the following measures:
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| * Do not drink excessive alcohol. [[Alcohol]] is one of the most common causes of chronic [[Alcoholic liver disease|liver disease]] in North America.
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| * 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.
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| * Get vaccinated against epatitis A and B. it is highly recommended that one get vaccinated against hepatitis B. This chronic [[infection]] is highly contagious and one of the complications is liver cancer.
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| * 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|liver enzymes checked]] to make sure that the liver is functioning fine.
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| * 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.
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| * 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.
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| * Eat healthy exercise and keep your weight down. [[Obesity]] is a well known cause of chronic fatty liver disease <ref>[http://www.liverfoundation.org/education/info/progression/ The Progression of Liver Disease] American Liver Foundation - 27/01/2007/</ref>.
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| ==See Also==
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| * [[Hepato-biliary diseases]]
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| ==References==
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| {{reflist|2}}
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| {{Gastroenterology}} | | {{Gastroenterology}} |
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| | [[Category:Hepatology]] |
| | [[Category:Disease]] |
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