Liver Disease Classification
Liver disease has multiple aetiologies classified by a consistent framework. Understanding the A–E system enables systematic workup of any patient presenting with liver disease.
✦ The Mnemonic
"ABCDE Classifies Liver Disease"
Alcohol · NAFLD/NASH · Autoimmune · Viral hepatitis B/C · Drugs/hereditary + Endstage (cirrhosis)
Clinical Breakdown
Liver function tests (LFTs) interpretation: hepatocellular pattern (raised ALT + AST predominantly) = hepatocyte damage; cholestatic pattern (raised ALP + GGT + bilirubin) = bile flow obstruction. Bilirubin alone can be raised in haemolysis or Gilbert's syndrome (benign UGT1A1 deficiency — unconjugated, no liver disease).
Cirrhosis complications: ascites (treat with salt restriction + diuretics; tap for SBP — neutrophils >250/mL = SBP, treat with cefotaxime + albumin), variceal bleeding (terlipressin + antibiotics + endoscopic band ligation + TIPSS if refractory), hepatic encephalopathy (lactulose, rifaximin — target 2–3 loose stools/day; treat precipitants), hepatorenal syndrome (terlipressin + albumin).
Child-Pugh score and MELD score quantify cirrhosis severity. MELD (Model for End-stage Liver Disease) uses bilirubin, creatinine, INR, and sodium — it predicts 3-month transplant-free survival and is used to prioritise liver transplant waiting lists.
⭐ Clinical Pearl
Hepatocellular carcinoma (HCC) arises in 80% of cases in cirrhotic liver. 6-monthly ultrasound + AFP screening is recommended in all cirrhotic patients. Surveillance detects early-stage disease amenable to curative resection, transplant, or ablation. HCV-associated HCC is a leading indication for liver transplantation worldwide.