Introduction are in the esophagus and stomach, which can
Chronic liver disease is defined as one occur- cause severe bleeding. Imaging, particularly ulring for over more than 6 months. The most im- trasonography, can show features of portal hyportant of this is cirrhosis, which is one among pertension and can indicate the cause.
the commonest cause of mortality. It is an irre- Case summary
versible alteration of hepatic architecture, char- A 57 year old man presented with complaints of
acterised by diffuse fibrosis and areas of nodu- dull pain in the right hypochondriac region, loss
lar regeneration. Although largely the result of of appetite and generalised weakness since 6
alcohol abuse, it can be caused by other factors months. The symptoms manifested gradually
like hepatitis, non-alcoholic fatty liver disease, with no history of fever, haematemesis or loss
biliary disease and autoimmune liver disease. of consciousness. Patient was not a known
Cirrhosis may be entirely asymptomatic or may hypertensive or diabetic. He had a habit of
present with nonspecific constitutional symp- taking alcohol. Sleep was sound, bowel and
toms or symptoms ofliver failure, complications bladder functions were normal. There was no
of portal hypertension or both. The portal family history of a similar disease.
venous pressure above 12mmHg usually results The patient was well nourished and well built.
in the manifestation of clinical features. This He was afebrile, not anemic or cyanosed. Icterus
pressure is determined by the portal blood flow (+), no lymphadenopathy and no clubbing. Vital
and portal vascular resistance. Portal venous signs were within normal limits. Systemic
congestion and collateral vessel formation con- examination – CVSIRS/CNS – NAD. In alimentary
tribute to the clinical features of portal hyper- system, tongue and fauces were normal. Abdotension. The most important collateral vessels men was flabby, there was no tenderness. Liver