F Liver diseases 46. What could be the problems in diagnosis and treatment of viral hepatitis? The clinical features of chronic hepatitis are extremely variable and clinical course of viral hepatitis is unpredictable. The patient may experience spontaneous remission or may have indolent disease without progression for many years. Conversely some patients have rapidly progressive disease that may develop liver failure and hepatic encephalopathy within a few years. The variable presentation of the disease poses diagnostic and treatment related challenges. 47. Whether the death due to chronic liver disease can occur all of a sudden without showing any symptom /recognizable signs or not? The characteristic clinical consequences of liver disease are: jaundice, cholestasis (scratch marks due to pruritus), hypoglycaemia, fetor hepaticus, palmar erythema, spider angioma, hypogonadism, gynaecomastia, weight loss, muscle wasting, cirrhotic liver, ascites, splenomegaly, haemorrhoids, caput medusa in abdominal skin, oesophageal varices, gastro-intestinal bleeding, hepatic encephalopathy, multi-organ failure etc. Whatever the sequence, 80% to 90% of liver function capacity must be eroded before liver failure ensues. Chronic liver disease is the most common route to liver failure ultimately leading to cirrhosis. It is very unlikely for a person to die suddenly due to chronic liver disease in absence of any of the signs of liver failure. 48. Whether cirrhosis may remain silent or asymptomatic for a long period? Or can cirrhosis develop all of a sudden? All forms of cirrhosis may be clinically silent. When symptomatic they lead to non-speci ic clinical manifestations like loss of appetite, weight loss, weakness, osteoporosis and in advanced disease frank ibrillation (severely disturbed heart function) may develop. The ultimate mechanism of most cirrhotic deaths is 1. Progressive liver failure, 2. Complication related to portal hypertension or 3. Development of liver cancer. MEDICAL DIMENSION OF FREQUENTLY ENCOUNTERED CASES | 44