Clinical assessment of liver disease

Chronic liver disease is increasingly common in the UK, and now causes in excess of 5000 deaths per year. The natural history of liver injury is of increasing fibrosis in response to hepatocellular injury, which is usually asymptomatic until decompensation occurs. Up until this point, elevated liver enzyme concentrations are the only indicators of disease. Thorough investigation of abnormal liver function tests is therefore essential to produce a diagnosis at a stage where the underlying disease is likely to be treatable. Clinical stigmata of chronic liver disease are not present in the absence of severe fibrotic liver disease and, if present, should cause concern. Non-alcoholic fatty liver disease is now the commonest cause of elevated liver enzymes, whereas alcohol remains the commonest cause of death from cirrhosis and its complications.