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, it is usually identified only by the presence of elevated liver enzyme levels. Thorough investigation of abnormal LFTs is therefore essential to produce a diagnosis at a stage where the underlying disease is likley to be treatable. Clinical stigmata of chronic liver disease are not present in the absence of severe fibrotic liver disease so, if present, should cause concern. Non-alcoholic fatty liver disease is now the commonest cause of liver enzyme elevations, whereas alcohol remains the commonest cause of death from cirrhosis and its complications.