CLDs

CLDs commonly refers to chronic liver diseases, a group of conditions characterized by long-standing injury to hepatic tissue and progressive impairment of liver function. They can progress to cirrhosis and liver failure and increase the risk of hepatocellular carcinoma. The umbrella includes fatty liver disease, viral hepatitis, autoimmune liver disease, cholestatic diseases, and other chronic hepatopathies.

Common conditions within CLDs include nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease, chronic hepatitis B and C, autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. Together they can produce a spectrum from simple steatosis to cirrhosis with complications such as portal hypertension and hepatic insufficiency.

Pathophysiology involves ongoing hepatocellular injury, inflammation, and fibrosis that remodel liver architecture over time. This process can lead to portal hypertension, reduced synthetic function, and increased risk of liver cancer. The course varies by etiology and stage and may be silent for years.

Risk factors commonly include obesity, type 2 diabetes, metabolic syndrome, excessive alcohol intake, chronic viral hepatitis, older age, and certain genetic predispositions. Prevention focuses on modifying these factors and early detection of liver injury in at-risk individuals.

Diagnosis typically combines laboratory tests (liver enzymes, bilirubin, albumin, platelets), imaging (ultrasound, elastography, CT or MRI), and noninvasive fibrosis scores (such as FIB-4 or NAFLD fibrosis score). Liver biopsy may be used when uncertainty remains or to characterize specific diseases.

Management aims to treat the underlying cause, slow progression, and prevent complications. This includes lifestyle changes, weight loss, vaccination against hepatitis A and B, antiviral therapy for viral hepatitis, disease-specific therapies, and management of cirrhosis-related complications. In advanced cases, liver transplantation may be considered.