Clinical and laboratory assessment of symptomatic and asymptomatic liver disease

Chronic liver disease is rising in incidence and prevalence in the UK and carries a significant mortality as well as socioeconomic burden for individuals, their families and health services. Although the causes of liver disease are many, the vast majority of liver disease is preventable and related to excess alcohol consumption, being overweight/obese or the acquisition of hepatitis B and or C. However, less common causes of liver disease should not be overlooked, especially as effective specific therapies may be available; this is the case for autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and haemochromatosis. A major challenge in assessing liver disease is that it is typically ‘silent’ or asymptomatic until the later stages, i.e. when decompensation occurs. There are exceptions to this, such as pruritis in PBC or jaundice in acute viral or AIH, but these scenarios are very much in the minority when considering the totality of the liver disease burden in any given population. A thorough clinical history, including an accurate alcohol history, is needed, with a systematic approach using and understanding the risk factors for liver disease.