Chronic liver disease

Cause of chronic liver disease:(AAudiO)

• Infective: hepatitis
• drug: methydopa and methotraxate
• autoimmune - autoimmune hepatitis
• alchohol
• other: primary biliary cirhosis, wilson's disease.

complication: HEPATIK

• hepatic encephalopathy
• Portal hypertension + varices 
• Ascites
• Tumour (hepatoma)
• Infection (spontanous bacterial peritonitis)
• Kidney (hepatorenal syndrome)

Examination: 

general inspection:

• confuse, drowsienss(hepatic encephalopathy), hyperpigmentation (heamotocromatosis)

hand :

• leukonychia, duputyren's contracture, flapping tremor, palmar erythema, fingger clubbing (5)

forearm: 

• scratch mark, tatoo, bruising, injection mark. (IVDU)

face

• scleral icterus, xanthelasma, parotid swelling

neck

• lymphadenopathy

chest 

• spider neavi, gyneacomastia, loss of axilary hair, 

abdomen

• caput medusa, dilated vein,  hepatomegally, ascites, loss of pubic hair, splenomegally

leg

• oedema

end examination:

other: testicular atrophy

ask history about alcohol, drug abuse.

Investigation: (aaudio)

• liver function test : gamma GT, liver damage, bilirubin 
• Full blood count : anemia(bleeding, folate def, alcohol), thrombocytopenia and leukopenoa (TL - hypersplensim)
• coagulation profile - lbleeding tendency
• hepatitis serology
• antimicrobial antibody (PCB)
• sm antibody, antinuclear antibody, anti-microsomal antibody - autoimmune hepatitis
• ascites fluid analysis
• ultrasound
• liver biopsy