Presentation of Complications of Chronic Liver Disease at a Tertiary Care Hospital

Abstract

Objectives:  To see presentations of various complications of chronic liver disease at a tertiary care hospital.  
Study Design: Retrospective study 
Place and Duration of Study:  This Study was conducted at Medical Unit 1, Nishtar Hospital, Multan for a period 
of 6 months from 01-01-2010 to 30-06-2010. 
Patients and Methods:  Patients admitted at Medical Unit 1, Nishtar Hospital, Multan were included in the study. 
The medical record of these patients was checked. The data obtained were entered in SPSS-11 and analyzed. 
Results:  A total number of 50 patients were studied, 30 (60%) were male and 20 (40%) were female. Age of the 
patients ranged from 36-58 years. Mean age of the patients was 45.39 ± 4.77 years. All the patients presented with 
fatigue, generalized weakness, oedema feet, anorexia and nausea.  Twenty (40%) patients presented with jaundice. 
Abdominal distension was present in 42 (84%) patients.  Twenty two (44%) patients were having altered 
consciousness. Twenty three (46%) patients presented with haemetemesis and 28 (56%) with malena. Low grade 
fever was present in 26 (52%) patients. Epistaxis was present in 2 (4%) patients. Previous history of jaundice was 
present in 40 (80%) patients and history of alcohol intake was present in 12 (24%) cases.  
On examination, all the patients were found emaciated with protuberant abdomen. Twenty (40%) were clinically 
jaundiced. Oedema feet was detected in 48 (96%) patients. Palmar erythema was present in 26 (52%).  Hepatic flaps 
were present in 24 (48%) patients. Shifting dullness and fluid thrill was present in 46 (92%) patients and engorged 
paraumblical veins were present in 36 (72%) patients.  Splenomegaly was seen in 36 (72%) patients. 
Laboratory investigations revealed raised serum bilirubin in 26 (52%) patients and level of bilirubin was 3-6 mg/100 
ml in most of the cases. ALT levels were raised in 33 (66%) patients above the twice of the upper limit of the 
normal value. Serum alkaline phosphatase was raised only in 1(2%) of patients. Platelet count was below 70000 in 
32 (64%) patients. Anti HCV and HBsAg were detected in 38 (76%) and 12 (24%) patients respectively. 
Prothrombin time was prolonged ≥5 seconds (than control) in 36 (72%) patients. Serum albumin was less than 3 
g/100 ml in all cases. 
Abdominal ultrasonography revealed coarse echotexture with nodular liver in 46 (92%) patients. Ascites was 
detected in 48 (96%) patients.  Two patients (4%) had hepatic mass. 
Upper GI endoscopy revealed esophageal varices in 33 (66%) patients, fundal varices in 12 (24%) patients, gastric 
ulceration in 17 (34%) patients and duodenal ulceration in 11 (22%) patients.  
Conclusion: Patients of chronic liver disease present in tertiary care hospital at a very late stage of the disease and 
most common presentations are ascites,  hepatic encephalopathy, upper GI bleeding and low grade fever. Awareness 
may be created to motivate the patients to report to tertiary care hospital at an early stage, so that development of 
these complications can be managed at the very initial stage