Comprehensive Practical Hepatology

Acute and chronic liver disease is a global endemic healthcare concern. More than 500 million people around the world are infected with the hepatitis B or C virus. Approximately 500,000 patients die ...
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Approach to Patients with Chronic Liver Injury

Pp. 77-120 (44)

Yukihiro Shimizu


Patients presenting with chronic liver injury should be classified as having hepatocellular, cholestatic or mixed injury, because classification can narrow the causes of injury, making history taking and physical examination more effective. Diagnosis of drug- and alcohol-induced liver injury depends on careful history taking. Most patients with chronic liver diseases are asymptomatic, and key examinations for the diagnosis of each disease should be performed in an effective order. Severity of liver injury is estimated by PT-INR and T-Bil. Patients at risk for transition to hepatic failure should likely be transferred to a transplantation center.


Autoimmune liver disease, cholestatic type, chronic liver injury, hepatocellular carcinoma, hepatocellular type, hereditary liver disease, liver cirrhosis, medical history, physical examination, viral hepatitis.


Gastroenterology Center, Nanto Municipal Hospital, Toyama, Japan.