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Although many different pathogenic agents and processes can affect the liver (Table 14–1), they are generally manifested in individual patients in a limited number of ways that can be assessed by evaluation of some key parameters. Liver disease can be acute or chronic, focal or diffuse, mild or severe, and reversible or irreversible. Most cases of acute liver disease (eg, caused by viral hepatitis) are so mild that they never come to medical attention. Transient symptoms of fatigue, loss of appetite, and nausea are often ascribed to other causes (eg, flu), and minor biochemical abnormalities referable to the liver that would be identified in blood studies are not discovered. The patient recovers without any lasting medical consequences. In other cases of acute liver injury, symptoms and signs are severe enough to call for medical attention. The entire range of liver functions may be affected or only a few, as is the case with liver injury resulting from certain drugs that cause isolated impairment of the liver’s role in bile formation (cholestasis). Occasionally, viral and other causes of acute liver injury occur in an overwhelming manner, resulting in massive liver cell death. This syndrome of fulminant hepatic failure carries a high mortality rate; however, if the patient survives, liver function returns to normal and there is no residual evidence of liver disease.

Table 14–1 Categories of Liver Disease by Presentation.

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