Chronic liver disease (CLD) is a progressive deterioration of liver functions for more than six months, which includes synthesis of clotting factors, other proteins, detoxification of harmful products of metabolism, and excretion of bile. It refers to chronic conditions that do progressive damage to your liver. Viral infections, toxic poisoning and certain metabolic conditions are among the common causes of chronic liver disease.

CLD progresses in roughly 4 stages:

1.     Hepatitis

2.     Fibrosis

3.     Cirrhosis

4.     Liver failure

Symptoms:

·       Jaundice- yellowish coloration of skin, eyes, mucus membrane

·       Dark-colored urine

·       Light colored stool

·       Indigestion

·       Weight and muscle loss

·       Musty-smelling breadth

·       Hepatic encephalopathy

·       Pruritis

·       Nail clubbing

·       Ascites with associated pedal edema

Complications:

1.     Decompensated cirrhosis with liver failure

2.     Portal Hypertension with associated Upper GI bleeding

3.     Liver cancer

Management:

1.     Antiviral

2.     Diuretics

3.     Corticosteroids

4.     Immunosuppressants

5.     Liver transplant

In chronic liver disease, prescribe drugs to a minimum, prefer drugs that do not need hepatic metabolism for elimination, lowest effective dose of a drug, avoiding hepatotoxic drug. Drugs that precipitate hepatic coma are: anxiolytics, hypnotics, frusemide, phenobarbitone, promethazine, opioids. Ask the patient to bring a list of all the prescription and non- prescription medication, including herbs, vitamins and supplements to every physician’s appointment. If the patient is taking several medications, make sure the ingredients are not the same. Explore if the patient drinks a significant amount of alcohol daily, avoid or restrict the use of acetaminophen