Chronic Liver Disease

Dr Md Nazrul Islam
MCPS,FCPS (Paed).MD (Neonatology)
Assistant Professor
Dept of Neonatology
Definition

Chronic liver disease is defined as

liver injury occurring over more than 6
months.

Chronic liver diseases include –

Chronic hepatitis
Cirrhosis of the liver
Chronic Hepatitis

Chronic hepatitis is defined as

continuing inflammation of liver
parenchyma for 6 months and
manifested by persistence of elevated
hepatic transaminases that resolves
with or without treatment or
progresses to cirrhosis.
Cirrhosis Of The Liver

It is a form of chronic liver disease

characterized by fibrosis ,disruption of
parenchymal architecture with
formation of regenerative nodule.
Etiology
Chronic viral hepatitis Metabolic
(HBV ,HCV HDV, EBV, Hemochromatosis
CMV)
Wilson disease
Drugs-Alcohol, MTX,
α1-antitrypsin deficiency
INH, Methyl dopa
Cryptogenic
(Unknown)
Immune Indian childhood
Primary sclerosing cirrhosis
cholangitis
Autoimmune liver
disease
Biliary
Primary biliary cirrhosis
Cystic fibrosis
Morphological Classification

Micronodular
Small nodules of <1 cm.
Macronodular
Large nodules up to 5 cm in diameter
Mixed
Clinical classification

Compensated cirrhosis
Usually symptom less
Mild fever, spider, palmar erythema,
vascular collateral, firm hepatomegaly
and/or splenomegaly
Clubbing
Normal or increased ALT
Clinical Classification Continued…

Decompensated cirrhosis
Features of hepatocellular failure
Features of portal hypertension
Features of complications
Etiological Classification

Post hepatic (after acute or chronic

hepatitis)

Post necrotic (after toxic injury)

Biliary cirrhosis (chronic biliary

obstruction)
Symptoms

May be asymptomatic
Fatigue
Weight loss
Anorexia
Nausea
Vomiting
Upper abdominal discomfort
Signs
Jaundice
Circulatory changes
Spider telangiectasia
Palmar erythema
Pruritus, Pigmentation, Digital clubbing
Endocrine changes
Hair loss
Testicular atrophy
Irregular menstruation
Hepatomegaly – Non-tender, hard,
irregular
Signs…
Hemorrhagic tendency – Bruise, purpura,
epistaxis
Ascites
Portal hypertension
Splenomegaly
Collateral vessels
Variceal bleeding
Growth retardation
Hepatic encephalopathy
Others – signs of complication
Complications Of Cirrhosis In Children

Coagulopathy
Hypoalbuminemia
Portal hypertension
Infection – Spontaneous bacterial
peritonitis
Hepatorenal syndrome
Hepatopulmonary syndrome
Hepatocellular carcinoma
Investigations
Liver function tests
Serum bilirubin
ALT
Prothrombin time
Serum albumin
Serum alkaline phosphatase

Viral markers
Metabolic screening
Endoscopy of the upper gastrointestinal tract (to see the
varices)
Ultrasonography of the Hepatobiliary system
Liver biopsy
Supportive Treatment

Diet
Protein restricted if ascites,
encephalopathy
Salt restricted if ascites, edema
Diuretics – Spironolactone
Antibiotics if infection
Vitamin supplementation – K, A, D & E
Specific Treatment

Liver transplantation
Prognosis

Overall – Poor
25% survive – 5 years
50% survive 5 years and 25% up to
10 years when LFT good

Prognosis is good if underlying cause

can be corrected e.g. Wilson disease
Portal Hypertension
THANK YOU
Definition

Elevation of portal pressure >10-12

mm of Hg

Normal portal venous pressure ≈ 7

mm of Hg
Etiology

Extrahepatic portal hypertension

Portal vein thrombosis
Splenic vein thrombosis
Umbilical infection
Primary peritonitis
Acute appendicitis
Etiology…
Intrahepatic portal hypertension
Hepatocellular disease
Acute & chronic viral hepatitis
Cirrhosis of the liver
Congenital hepatic fibrosis
Wilson disease
Drugs - Methotrexate
Biliary tract disease
Extrahepatic biliary atresia
Cystic fibrosis
Sclerosing cholangitis
Etiology…

Idiopathic portal hypertension

Post sinusoidal obstruction

Budd-Chiari syndrome
Veno-occlusive disease
Clinical Features

Variceal bleeding from upper GIT

Ascites
Prominent veins on anterior
abdominal wall
Pallor due to hemorrhage or
hypersplenism
Splenomegaly
Investigations
Endoscopy of upper GIT
USG of Hepatobiliary system including
Color Doppler
Portal vein thrombosis
Collaterals
Splenomegaly
Portal venography for mapping vascular
anatomy
Liver function tests
Portal venous pressure measurement by
Balloon Catheter (rarely needed)
Complications Of Portal Hypertension

Variceal bleeding
Congestive gastropathy
Hypersplenism
Ascites
Renal failure
Hepatic encephalopathy
Management Of Acute Variceal Bleeding

Resuscitation
Intravenous fluid
Blood transfusion
Vitamin K
Injectable Vasopressin
H2-receptor blockers
Nasogastric tube suction
Local measures
Sclerotherapy
Banding
Balloon tamponade
Long-term Management

Propranolol – Decreases portal

pressure; limited use in children
Sclerotherapy
Band ligation
TIPSS
Portosystemic shunt surgery
Prognosis
Depends on severity of hepatocellular
disease
Intrahepatic portal hypertension has a poor
prognosis; may need liver transplantation
Extrahepatic portal hypertension can be
treated conservatively
Triad of Jaundice, Ascites &
Encephalopathy is associated with 80%
mortality