ST.EMLYN'S
... Many people with chronic liver disease are asymptomatic. It takes a seriously cirrhosed liver to cause symptoms. If I’ve a patient with an incidental finding of deranged liver function tests in an otherwise well person, other than counselling about lifestyle changes I would refer these people back to primary care for investigation. The patients I’m worried about in the ED are those who have decompensated. They present with deteriorating liver function, jaundice, encephalopathy or renal dysfunction. There’s often a precipitant to the deterioration. GI bleeding (variceal and non-variceal), infection, alcohol and constipation are common but others such as acute portal vein thrombosis, and transformation to hepatocellular carcinoma need to be considered...