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Other Causes of chronic liver disease

Liver function tests are undertaken on a great number of patients with a wide variety of symptoms. The abnormalities found may be mild (for example an isolated rise in ALT of less than 70iu/l) or more marked with associated derangement of bilirubin levels, clotting factors and blood albumin and protein levels. More significant abnormalities may require referral for specialist investigation and treatment. More mild abnormality may be indicative of chronic liver disease which also requires investigation and potentially treatment as even mildly abnormal liver tests may pose a risk of significant liver damage if they persist for long periods.

Whilst patients with more markedly abnormal liver tests may require urgent investigation and specialist referral those with mild abnormalities should undergo further testing to exclude treatable causes. Such investigation should include, cholesterol and HbA1c, since fatty liver disease, the commonest cause of abnormal liver tests in high income countries, is strongly associated with the risk of diabetes, hyperlipidaemia and cardiovascular risk. Alcohol intake is also a significant factor and the combined effects of excess calorie intake and alcohol have greater than additive effect in those who are susceptible to liver disease. The treatment of both fatty liver due to calorie excess and alcohol is to avoid the precipitating factors. For alcohol abstinence is the only way to guarantee successful treatment, for two reasons, firstly once the liver has become inflamed even small amounts of irritation (in the form of alcohol) can perpetuate ongoing damage, secondly individuals who have established patterns of excess alcohol consumption, often struggle to drink in moderation under any circumstances so not drinking at all often offers a clear line of demarcation. Chronic (longstanding) viral infections affecting the liver include hepatitis B and hepatitis C, for which there are specific therapies. Haemochromatosis (a disorder of iron metabolism) should also be screened for as should auto-immune liver disease (auto-antibodies, immunoglobulins). In patients with a family history of liver disease or who have other traits suggestive of the diseases alpha-1 -antitrypsin (emphysema), Wilsons disease (a hereditary disorder of copper metabolism that may cause eye and psychiatric disease, usually in young people) and primary sclerosing cholangitis (Inflammatory bowel disease). Tumours may also cause abnormal liver function. It should also be born in mind that certain drugs including flucloxacillin (especially in older men), non-steroidals and statins may cause abnormal liver function.

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