chronic liver disease

• 慢性肝疾患

WordNet

1. pursue a positive and satisfying existence; "You must accept yourself and others if you really want to live"
2. actually being performed at the time of hearing or viewing; "a live television program"; "brought to you live from Lincoln Center"; "live entertainment involves performers actually in the physical presence of a live audience" (同)unrecorded
3. abounding with life and energy; "the club members are a really live bunch"
4. charged with an explosive; "live ammunition"; "a live bomb"
5. exerting force or containing energy; "live coals"; "tossed a live cigarette out the window"; "got a shock from a live wire"; "live ore is unmined ore"; "a live bomb"; "a live ball is one in play"
6. highly reverberant; "a live concert hall"
7. in current use or ready for use; "live copy is ready to be set in type or already set but not yet proofread"
8. lead a certain kind of life; live in a certain style; "we had to live frugally after the war"
9. not recorded; "the opera was broadcast live"
10. of current relevance; "a live issue"; "still a live option"
11. an impairment of health or a condition of abnormal functioning
12. a person who has a special life style; "a high liver"
13. large and complicated reddish-brown glandular organ located in the upper right portion of the abdominal cavity; secretes bile and functions in metabolism of protein and carbohydrate and fat; synthesizes substances involved in the clotting of the blood; sy
14. liver of an animal used as meat
15. someone who lives in a place; "a liver in cities"
16. being long-lasting and recurrent or characterized by long suffering; "chronic indigestion"; "a chronic shortage of funds"; "a chronic invalid"
17. of long duration; "chronic money problems" (同)continuing
18. habitual; "a chronic smoker" (同)inveterate
19. caused by or altered by or manifesting disease or pathology; "diseased tonsils"; "a morbid growth"; "pathologic tissue"; "pathological bodily processes" (同)morbid, pathologic, pathological

PrepTutorEJDIC

1. 『生きている』,生命がある / 《副詞[句]を伴って》〈人などが〉『生き続ける』 / 〈物事が〉長く続く,存続する / 《場所を表す副詞[句]を伴って》〈人などが〉『住む』,居住する / 《副詞[句]を伴って》『生活する』,暮らす / 生人を楽しむ,おもしろく桟らす / 《a+形容詞癌lifeを目的語にして》〈…を生活〉‘を'する / 〈思想など〉‘を'実銭する
2. 《名詞の前にのみ用いて》『生きている』 / 『活気のある』 / (問題などが)当面の / 燃えている / (弾丸などが)まだ爆発してない,未発の / まだ動いている(働いている),有効な / 電流が通じている / (放走が)生の,実況の
3. (体の)『病気』,疾患 / (精神・道徳などの)病気,病弊
4. 女性の話術芸人 =diseur
5. (ある態度で)生活する人;居住者
6. 〈C〉『肝臓』 / 〈U〉(食用にする)動物の肝臓,レバー
7. (病気が)長期にわたる,慢性の / 《名詞の前にのみ用いて》常習の,癖になった
8. 病気にかかった / 病的な,不健全な(morbid)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/30 19:47:05」(JST)

wiki en

[Wiki en表示]

Chronic liver disease in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. Chronic liver disease refers to disease of the liver which lasts over a period of six months. It consists of a wide range of liver pathologies which include inflammation (chronic hepatitis), liver cirrhosis, and hepatocellular carcinoma. The entire spectrum need not be experienced.

Causes

The list of conditions associated with chronic liver disease is extensive and can be categorised in the following way:

Viral causes

• Hepatitis B
• Hepatitis C

Cytomegalovirus (CMV), Epstein Barr virus (EBV), and yellow fever viruses cause acute hepatitis.

Toxic and drugs

• Alcoholic liver disease
• Rarely drug induced liver disease from methotrexate, amiodarone, nitrofurantoin and others

Paracetamol (acetaminophen) causes acute liver damage.

Metabolic

• Non-alcoholic fatty liver disease
• Haemochromatosis
• Wilson's Disease

Autoimmune

• Autoimmune hepatitis
• Primary biliary cholangitis (primary biliary cirrhosis)
• Primary sclerosing cholangitis

Other

• Right heart failure

Complications of chronic liver disease

• Portal hypertension
  • Ascites
  • Hypersplenism (with or without splenomegaly)
  • Lower oesophageal varices and rectal varices

• Synthetic dysfunction
  • Hypoalbuminaemia
  • Coagulopathy
• Hepatopulmonary syndrome
• Hepatorenal syndrome

• Encephalopathy

• Hepatocellular carcinoma

Physical signs

Signs of chronic liver disease detectable on clinical examination can be divided into those that are associated with the diagnosis of chronic liver disease, associated with decompensation and associated with the aetiology.

Signs associated with diagnosis of chronic liver disease

• Clubbing
• Palmar erythema
• Spider nevi (angiomata)
• Gynaecomastia
• Feminising hair distribution
• Testicular atrophy
• Small irregular shrunken liver
• Anaemia
• Caput medusae

Signs associated with decompensation

• Drowsiness (encephalopathy)
• Hyperventilation (encephalopathy)
• Metabolic flap/asterixis (encephalopathy)
• Jaundice (excretory dysfunction)
• Ascites (portal hypertension and hypoalbuminaemia)
• Leukonychia (hypoalbuminaemia)
• Peripheral oedema (hypoalbuminaemia)
• Bruising (coagulopathy)
• Acid-base imbalance, most commonly respiratory alkalosis

Signs associated with the aetiology

• Dupuytren's contracture (alcohol)
• Parotid enlargement (alcohol)
• Peripheral neuropathy (alcohol and some drugs)
• Cerebellar signs (alcohol and Wilson's disease)
• Liver enlargement (alcohol, NAFLD, haemochromatosis)
• Kayser-Fleisher rings (Wilson's disease)
• Increased pigmentation of the skin (haemochromatosis)
• Signs of right heart failure

Note that other diseases can involve the liver and cause hepatomegaly but would not be considered part of the spectrum of chronic liver disease. Some examples of this would include chronic cancers with liver metastases, infiltrative haematological disorders such as chronic lymphoproliferative conditions, chronic myeloid leukaemias, myelofibrosis and metabolic abnormalities such as Gaucher's disease and glycogen storage diseases.

Recognition

Chronic liver disease takes several years to develop and the condition may not be recognised unless there is clinical awareness of subtle signs and investigation of abnormal liver function tests.

Testing for chronic liver disease involves blood tests, imaging including ultrasound and a biopsy of the liver. The liver biopsy is a simple procedure done with a fine thin needle under local anaesthesia. The tissue sample is sent to a laboratory where it is examined underneath a microscope.

Risk factors for various liver diseases

These differ according to the type of chronic liver disease.

• Excessive alcohol use
• Obesity
• Metabolic syndrome including raised blood lipids
• Health care professionals who are exposed to body fluids and infected blood
• Individuals who get multiple tattoos and body piercing
• Sharing infected needle and syringes
• Having unprotected sex and multiple sex partners
• Working with toxic chemicals without wearing safety clothes
• Certain prescription medications

Treatment

The treatment of chronic liver disease depends on the cause. Specific conditions may be treated with medications including corticosteroids, interferon, antivirals, bile acids or other drugs. Supportive therapy for complications of cirrhosis include diuretics, albumin, vitamin K, blood products, antibiotics and nutritional therapy. Other patients may require surgery or a transplant. Transplant is required when the liver fails and there is no other alternative.

Alternative medicine

Some herbal remedies have been advocated for chronic liver disease but the evidence is not conclusive. Some common herbs are known to be harmful to the liver, including black cohosh, ma huang, chaparral, comfrey, germander, greater celandine, kava, mistletoe, pennyroyal, skull cap and valerian.

References

UpToDate Contents

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• 1. 肝硬変患者に対する診断的アプローチ diagnostic approach to the patient with cirrhosis
• 2. 肝硬変の合併症、予後、およびマネージメントの概要 overview of the complications prognosis and management of cirrhosis
• 3. 肝硬変患者における腹水の初期治療 initial therapy of ascites in patients with cirrhosis
• 4. 肝疾患患者における凝固異常 coagulation abnormalities in patients with liver disease
• 5. 肝線維症の病因 pathogenesis of hepatic fibrosis

English Journal

• 13C-Methacetin Breath Testing in Patients with Non-Alcoholic Fatty Liver Disease.

• Kempiński R1, Neubauer K1, Wieczorek S2, Dudkowiak R1, Jasińska M1, Poniewierka E1.
• Advances in clinical and experimental medicine : official organ Wroclaw Medical University.Adv Clin Exp Med.2016 Jul-Aug;25(1):77-81. doi: 10.17219/acem/60878.
• BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a very common chronic liver condition which may potentially develop into fibrosis and cirrhosis. Liver biopsy is still the gold standard for liver fibrosis detection in these patients. However, non-invasive tools for liver assessment in NAFLD
• PMID 26935501

• A new form of chronic inflammatory bowel disease associated with chronic liver disease.

• Fascì-Spurio F1, Pavlidis P2, Bjarnason I2.
• Scandinavian journal of gastroenterology.Scand J Gastroenterol.2016 Jun;51(6):644-5. doi: 10.3109/00365521.2015.1128141. Epub 2016 Jan 5.
• PMID 26728083

• Is nonalcoholic fatty liver disease a risk factor for chronic kidney disease?

• Ozturk K1, Demirci H, Kurt O, Kantarcioglu M.
• European journal of gastroenterology & hepatology.Eur J Gastroenterol Hepatol.2016 May;28(5):608-609.
• PMID 27010477

Japanese Journal

• Epstein-Barr Virus-positive T-cell Lymphoproliferative Disease Following Umbilical Cord Blood Transplantation for Acute Myeloid Leukemia

• Journal of Nippon Medical School 83(1), 35-42, 2016
• NAID 130005132782

• Chlorogenic acid from honeysuckle improves hepatic lipid dysregulation and modulates hepatic fatty acid composition in rats with chronic endotoxin infusion

• Journal of Clinical Biochemistry and Nutrition 58(2), 146-155, 2016
• NAID 130005132517

• Fontan手術後の鬱血肝を背景に発生した肝細胞癌の1切除例

• 日本消化器外科学会雑誌 49(2), 99-107, 2016
• NAID 130005128388

Related Links

• Chronic Liver Disease Causes, Symptoms And Treatment

Chronic liver disease causes can be any condition that results in the gradual degradation and renewal of the tissue cells with a body’s liver. This process usually results in fibrosis or cirrhosis and can be potentially fatal in cases of ...

• Symptoms of Chronic liver disease - RightDiagnosis.com

Symptoms of Chronic liver disease The list of signs and symptoms mentioned in various sources for Chronic liver disease includes the 32 symptoms listed below: Progressive destruction of the liver May be asymptomatic in early or ...

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★リンクテーブル★

リンク元	「CLD」
拡張検索	「alcoholic chronic liver disease」
関連記事	「disease」「chronic」「live」「liver disease」「liver」

「CLD」

　　[★]

• 慢性肝疾患 chronic liver disease
• 慢性肺疾患 chronic lung disease

「alcoholic chronic liver disease」

　　[★] アルコール性慢性肝疾患

「disease」

　　[★]

• n.

疾患：illnessより厳密な概念。「ある臓器に明確な障害が確認され、それによって症状が出ているとはっきり説明できる場合」 (PSY.9)

特定の原因、病態生理、症状、経過、予後、病理組織所見が全てそろった場合 (PSY.9)

• something that is very wrong with people's attitudes, way of life or with society.

関

ail、ailment、disease entity、disorder、ill、illness、malady、sick、sickness

• 注意

disease ≠ illness ≠ disorder

　 　 　

「chronic」

　　[★]

• adj.

• 慢性の、慢性的な、慢性型の

関

chronically、chronicity

　 　 　 　

「live」

　　[★]

[liv]

• vt.
• vi.

---

[laiv]

• adj.

同

LAIV

　 　 　 　 　 　 　 　 　 　 　 　

「liver disease」

　　[★] 肝疾患、肝臓病、肝臓疾患

「liver」

　　[★] 肝臓