Case history
Case history #1
A 56-year-old man with a remote history of intravenous drug use presents to an initial visit complaining of increased abdominal girth but denies jaundice. He drinks about 2 to 4 glasses of wine with dinner and recalls having had abnormal liver enzymes in the past. Physical examination reveals spider naevi, a palpable firm liver, mild splenomegaly, and shifting dullness consistent with the presence of ascites. Liver function is found to be deranged with elevated aminotransferases (aspartate aminotransferase [AST]: 90 U/L, alanine aminotransferase [ALT]: 87 U/L), and the patient is positive for anti-hepatitis C antibody.
Case history #2
A 60-year-old woman with a past medical history of obesity, diabetes, and dyslipidaemia is noted to have abnormal liver enzymes with elevated aminotransferases (ALT: 68 U/L, AST: 82 U/L), and normal alkaline phosphatase and bilirubin. She denies significant alcohol consumption, and tests for viral hepatitis and autoimmune markers are negative. An abdominal ultrasound reveals evidence of fatty infiltration of the liver and slight enlargement of the spleen.
Other presentations
In the early stages of cirrhosis, patients may be completely asymptomatic or complain of unexplained fatigue, weakness, and/or weight loss. Patients may experience muscle cramps (about 64% prevalence), pruritus (39% prevalence), poor-quality sleep (63% prevalence), and sexual dysfunction (53% prevalence).[3]
Liver enzymes may be within the normal range or show only mild abnormality.
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