Radiology: a.ultrasonography; b.elastography; c.multidetector perfusion CT. And finaly- biopsy under US-guidnes. We need to receive the answer about the level of the liver fibrosis - the main pathognomonic stigmata of chronic liver disease.

Hi,

It's maybe changes of morphological features?

Clinical stigmata of chronic liver disease are well known since long time ago. Most of them are manifestation of estrogen effects. The most typical are: spider angioma, palmar eriyhema, gynecomastia, testicular atrophy, muscular atrophy among others. Nevertheless NONE of them are pathognomonic of liver disease. They only are useful for suspicion of chronic liver disease. Not all are present at the same time in the patient. The gold standard for diagnosis is liver biopsy. However, the combination of clinical stigmata  with image tests may increase diagnostic sensitivity and avoid risks of invasive procedures like biopsy..

Due to  advance diagnostic  tools ( Serology,  biochemistry and radiology) the  diagnosis of liver disease is not a difficult job

icterus, vomiting, diarrhea, coagulopathy, loss of weight, polyuria/polydipsia, everything could be, but nothing is always like in the book

ultrsonography of the abdomen can delineate the features of liver parenchyma and can make sure diagnosis of fatty liver, diabeatic granular liver , early diffuse liver disease or coarse liver parenchyma of cirrhosis . It also can diagnose liver fibrosis & wether its is fine or coarse fibrosis. So what is the difficulty now after US examination.

 Radiology: a.ultrasonography; b.elastography; c.multidetector perfusion CT. And finaly- biopsy under US-guidnes. We need to receive the answer about the level of the liver fibrosis - the main pathognomonic stigmata of chronic liver disease.

Hepatic peliosis is the only nosological entity.

Sorry but your request is incomplete. You should specify if your request regards chronic liver disease without cirrhosis or advanced liver disease; in the latter case you should specify if it is a compensated or decompensated liver cirrhosis.

Then I would suggest to distinguish if you are searching for histopathological, instrumental (echotomography, transient elastometry, CT scan, etc.) laboratory or clinical signs.

I would anticipate that aminotransferases elevation for more than six months and a transient elastography value > 6 KPa are the only non invasive signs of chronic liver disease without cirrhosis. Even steatosis not necessarily implicates the presence of a chronic liver disease.

Regarding this point, clinical stigmata are associated with advanced liver disease, either severe fibrosis or cirrhosis, more precisely with severe chronic liver insufficiency. Simple steatosis or acute liver disease does not show these signs frequently. It makes sense since, most of stigmata are manifestations of hyper estrogenic activity due to reduction of liver metabolism. Stigmata are then observed in compensated liver cirrhosis. Association of decompensate cirrhosis ( with liver related complications)  with stigmata has not been studied. Nevertheless in my opinion decompensation has little or none effect on stigmata manifestation, and clinically they are not relevant in these conditions, since in this situation  most patients are previously known as cirrhotic.  

None is specific, but increase in number of spiders, increase in size of a spider over a period of time or presence of more than five spiders at a point of time may be suggestive of CLD. In most of the cases of compensated CLD, the presentations are vague, non-specific & intermittent and they are usually diagnosed during routine physical & biochemical examinations.

The specidificty and sensitivity is around 70%

platelet count had a good relation with degree of liver fibrosis in most patients 

Mohsen Masoodi ·Platelets count  can  drop  by  many  of the  other diseases e.g.  malaria

Usually non specific.However,the development of portal hypertension is usually  revealed by the presence of thrombocytopenia.

It will be lucky if there is one.

A chronic liver disease may be argued only by the combination of different investigations including laboratory test able to indicate cytolysis (transaminases), cholestatsis (gammaGT, bilirubin, alkaline phosphatase), parenchimal function (albumin, prothrombin, cholinesterase, cholesterol, ammonium), immunological (immunoglobulin, protein elechtrophoresis, autoantibodies), viral (HBV, HCV), metabolic (ferritin, ceruloplasmin) and morphological (mainly transabdominal ultrasonography with information about volume, echoes reflection homogenicity, portal vein and biliary tract dilation, splenomegaly, ascites prsence/absence).

On these bases, a single pathognomonic stigmata does not exist.

And the elastography (Fibroscan) is now a very important test. The accuracy in the diagnosis of cirrhosis is around 80%, the same as liver biopsy. In our Liver Unit (Lisbon, Portugal) since the introdution of Fibroscan@ the numbers of liver biopsy has reduced around 90%. It is also very predictable in calculation of hepatocellular carcinoma.

Absolutely correct answer!

I think the "downvote" is a means to throw a rock and hide the hand; an innocent game for stupid people.

I would like to return you to the beggining. The question was :"Among the stigmata of chronic liver disease, is there a pathognomonic one?". So, the we need to receive simple and clear answer on  the very targeted question. Thank you

@Boris, all partecipants to this question are waiting for your "simple and clear anwer". It's not enough to judge good or bad the anwers of the others.

Thank you very much.

I know one: enlarged, hard liver.

Dear everybody

The simple and clear answer to this very targeted question is NO.

It was given above.

Thank you