Approach to the Patient with Liver Disease

The liver has a variety of important roles, including metabolism of food products from the gut, synthesis of proteins and clotting factors, detoxification of drugs, processing of lipids and bilirubin, and formation of bile. It also stores glycogen for conversion into glucose and helps contain infection by removing bacteria from the blood stream. Liver disease can result from a diffuse insult such as acute viral hepatitis or a more discrete process such as obstruction of the common bile duct by a gallstone. The pattern of the biochemical abnormality can provide important clues to the possible cause. Physical examination can elicit signs of chronic liver disease and portal hypertension, as well as more acute presentations such as a tender gallbladder in acute cholecystitis. An asymptomatic liver mass is a common clinical scenario, and its nature can often be determined by imaging. A number of hereditary disorders have prominent hepatic features, including Wilson disease, hemochromatosis, and alpha-1-antitrypsin deficiency.