Comprehensive Practical Hepatology

Approach to Patients with Chronic Liver Injury

Author(s): Yukihiro Shimizu

Pp: 77-120 (44)

DOI: 10.2174/9781681082059116010007

* (Excluding Mailing and Handling)

Abstract

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.


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

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      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 309824417 and j.to_ip >=309824417 )) and ((j.from_date <= 1740775696 and j.to_date >= 1740775696 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 8234) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 309824417 and j.to_ip >=309824417 )) and ((j.from_date <= 1740775696 and j.to_date >= 1740775696 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 8234) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 309824417 and j.to_ip >=309824417 )) and ((j.from_date <= 1740775696 and j.to_date >= 1740775696 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 8234)
      1.04msalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1887 and `b`.`banner_from_date` <= 1740775696 and `b`.`banner_to_date` >= 1740775696 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.57msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1887
      • 3: 1740775696
      • 4: 1740775696
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='3b53c8613d65c0903f9739503cfbecc4'
      1.68msalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:291
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    10Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        Atxg2rN3qL54qD61UTDim75JrS5EmlL1lDQmtSnX
        uc_cart_id
        3b53c8613d65c0903f9739503cfbecc4
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/8234" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/8234
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6IkRtNU5ZVkNZTzVkcDNWVlZNcjhCd1E9PSIsInZhbHVlIjoiQ2ZoNDFmSktKZUdGQTdIdlpsckp2blB4R0k3SEVWRTAzanFjL1hENU0rWT0iLCJtYWMiOiI4MTA1YzM2MTJkYzJmNDM4NjdlNTRlMDZkZjg5NmI5ODZhNzExZTczNjYzNTU0NTVhZTQ2ZGQzMmNlYWQxNGIxIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6IkRtNU5ZVkNZTzVkcDNWVlZNcjhCd1E9PSIsInZhbHVlIjoiQ2ZoNDFmSktKZUdGQTdIdlpsckp2blB4R0k3SEVWRTAzanFjL1hENU0rWT0iLCJtYWMiOiI4MTA1YzM2MTJkYzJm" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Fri, 28 Feb 2025 20:48:16 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6ImkrSzIyWkxBTmt6bEU1R2I4OWp6QWc9PSIsInZhbHVlIjoiRk91VXljTGwvUzlPVXNOeGpHS3B6Y05zZXo1eEtpS1FmZ0F0Ums1dTJBOGErR21QbVViek1wNmJuY09XUHNzUDczaStIcUJBR1ZkbVdmb3NzbEZ6S3RvRTQvUTEwZDNONW55aGhJVXE1QzhoOUVnUElFSXVkdjk2QzYydkJ1Ly8iLCJtYWMiOiI3YzkyNjMzOTMyNjI5YzNkOTJhYTdiN2MzY2Q4NDBlZmJhMGRmNTNlOWM2MTU5YmY1NWE2NTBlOThiYjZmMzNhIiwidGFnIjoiIn0%3D; expires=Mon, 03 Mar 2025 08:48:16 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6ImkrSzIyWkxBTmt6bEU1R2I4OWp6QWc9PSIsInZhbHVlIjoiRk91VXljTGwvUzlPVXNOeGpHS3B6Y05zZXo1eEtpS1FmZ0F0Ums1dTJBOGErR21QbVViek1wNmJuY09XUHNzUDczaStIc" 1 => "alphaeurekaselectnet_session=eyJpdiI6InhjMEE0ZnZKZXhPWWFHQWlWYnNGdGc9PSIsInZhbHVlIjoiWTUrQ0hNQ0tYRGV2UmFBb3ZYMTFoMi80b0lYS1V3RVN3Skhpc3E5aFpMSzVxdWJheHdqeHg5eGxuMSs2N0Rha1N4V0QzYVIwTlVRQ1hKS04vUHlBWE5xWEpnUDhUWlB2bklTSmY1enBFeldQSXU4dS9hYW9oUWdsRld4bWdzai8iLCJtYWMiOiIzZGYwZmJiODBiMDI4YjliMTg3ZGQ1NWZiNGZiNjkzNTk3MDA5M2RlZTNkZDhkZjZiNzNjMzFmZmI2NjJkNWI1IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6InhjMEE0ZnZKZXhPWWFHQWlWYnNGdGc9PSIsInZhbHVlIjoiWTUrQ0hNQ0tYRGV2UmFBb3ZYMTFoMi80b0lYS1V3RVN3Skhpc3E5aFpMSzVxdWJheHdqeHg5eGx" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6ImkrSzIyWkxBTmt6bEU1R2I4OWp6QWc9PSIsInZhbHVlIjoiRk91VXljTGwvUzlPVXNOeGpHS3B6Y05zZXo1eEtpS1FmZ0F0Ums1dTJBOGErR21QbVViek1wNmJuY09XUHNzUDczaStIcUJBR1ZkbVdmb3NzbEZ6S3RvRTQvUTEwZDNONW55aGhJVXE1QzhoOUVnUElFSXVkdjk2QzYydkJ1Ly8iLCJtYWMiOiI3YzkyNjMzOTMyNjI5YzNkOTJhYTdiN2MzY2Q4NDBlZmJhMGRmNTNlOWM2MTU5YmY1NWE2NTBlOThiYjZmMzNhIiwidGFnIjoiIn0%3D; expires=Mon, 03-Mar-2025 08:48:16 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6ImkrSzIyWkxBTmt6bEU1R2I4OWp6QWc9PSIsInZhbHVlIjoiRk91VXljTGwvUzlPVXNOeGpHS3B6Y05zZXo1eEtpS1FmZ0F0Ums1dTJBOGErR21QbVViek1wNmJuY09XUHNzUDczaStIc" 1 => "alphaeurekaselectnet_session=eyJpdiI6InhjMEE0ZnZKZXhPWWFHQWlWYnNGdGc9PSIsInZhbHVlIjoiWTUrQ0hNQ0tYRGV2UmFBb3ZYMTFoMi80b0lYS1V3RVN3Skhpc3E5aFpMSzVxdWJheHdqeHg5eGxuMSs2N0Rha1N4V0QzYVIwTlVRQ1hKS04vUHlBWE5xWEpnUDhUWlB2bklTSmY1enBFeldQSXU4dS9hYW9oUWdsRld4bWdzai8iLCJtYWMiOiIzZGYwZmJiODBiMDI4YjliMTg3ZGQ1NWZiNGZiNjkzNTk3MDA5M2RlZTNkZDhkZjZiNzNjMzFmZmI2NjJkNWI1IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6InhjMEE0ZnZKZXhPWWFHQWlWYnNGdGc9PSIsInZhbHVlIjoiWTUrQ0hNQ0tYRGV2UmFBb3ZYMTFoMi80b0lYS1V3RVN3Skhpc3E5aFpMSzVxdWJheHdqeHg5eGx" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "Atxg2rN3qL54qD61UTDim75JrS5EmlL1lDQmtSnX" "uc_cart_id" => "3b53c8613d65c0903f9739503cfbecc4" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/8234" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-28 20:48:16GET/chapter/82341121912