Chronic Liver Disease (CLD)

Symptoms:

1.       Right hypochondrial pain due to stretching of liver capsule as a result of hepatomegaly.

2.       Ankle swelling due to fluid retention.

3.       Gynaecomastia (enlargement of male breast), loss of libido and amenorrhea due to endocrine dysfunction.

4.       Pruritus due to cholestasis, this is often and early symptoms of primary biliary cirrhosis.

5.       Hematemasis and melena from GIT hemorrhage.

6.       Confusion and drowsiness due to neurological complicatin (hepatic encephalopathy).

Signs:

Skin

·         Palmar erythema: Indicating hyperdynamic circulation. (may also occur in pregnancy, thyrotoxicosis, rheumatoid arthritis, CO2 retention and old age).

·         Clubbing: occasionally occur.

·         Dupuytren’s contracture: (often in alcoholic cirrhosis).

·         Spider nevi: These are telangiectasias that consist of a central arteriole with radiating small vessels. They are found in the distribution of the superior vena cava (i.e. above the nipple line).

Abdomen

·         Initial hepatomegaly followed by small liver in well established cirrhosis.

·         Splenomegaly: Indicating portal hypertension.

Endocrine system

·         Testicular atrophy

·         Gynecomastia: enlargement of male breast occurs due to decreased estrogen metabolism in diseased liver, it also results from treatment with spironolactone, a diuretic commonly used for edema and edema and ascites in cirrhosis.

With complications:

·         Jaundice

·         Encephalopathy: (drowsiness, stupor, flapping tremor of outstretched hands and fetor hapaticus)

·         Collateral veins e.g. veins around the umbilicus forming caput medusae

·         Peripheral edema

·         Ascites 

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