Misdiagnosis of Chronic liver disease
Alternative diagnoses list for Chronic liver disease:
For a diagnosis of Chronic liver disease,
the following list of conditions
have been mentioned in sources
as possible alternative diagnoses
to consider during the diagnostic process for Chronic liver disease:
Diseases for which Chronic liver disease may be an alternative diagnosis
The other diseases for which Chronic liver disease
is listed as a possible alternative
diagnosis in their lists include:
Rare Types of Chronic liver disease:
Chronic liver disease Diagnosis: Book Excerpts
Common Misdiagnoses and Chronic liver disease
Chronic liver disease often undiagnosed: One study reported that 50% of patients
with a chronic liver disease remain undiagnosed by their primary physician.
The reasons are multifactorial.
Possible conditions include chronic hepatitis, cirrhosis of the liver, hemochromatosis,
or other types of liver condition.
See introduction to liver disease or misdiagnosis of liver disease.
Failure To Diagnose Chronic liver disease
Failure to diagnose Chronic liver disease may be associated with the following:
- Chronic liver disease is often undiagnosed as symptoms are often subtle enough to be ignored or unnoticed by the patient. Different patients can vary greatly in the type and severity of symptoms they present with which can make diagnosis difficult. Chronic liver disease tends to progress slowly and is often unnoticed for many years
- Sometimes patients have an undiagnosed chronic liver condition and then develop an infection which results in a presentation of acute liver disease which may mask the underlying chronic condition. For example, a patient with liver cirrhosis may develop acute hepatitis which may lead to a wrong diagnosis
- Chronic liver disease can have a range of presentations depending on the underlying cause. For example, end-stage liver disease due to hepatitis C may cause mild jaundice, hepatic encephalopathy, abdominal ascites and muscle wasting whereas end-stage biliary cirrhosis can cause severe jaundice, fatigue and itching
- The risk of liver cirrhosis due to alcohol can vary greatly amongst people - some people drink heavily and never have liver problems while other can develop liver cirrhosis from drinking as little as two drinks every day. Thus it is important not to rule out alcohol as a cause of liver disease even if the level of drinking is not considered a high risk.
- Hemochromatosis may be overlooked as a possible cause of infertility and impotence
Notes On Hidden Causes Of Chronic liver disease
The following may be hidden causes of Chronic liver disease:
- There is a large range of possible causes of chronic liver disease. Liver cirrhosis may be caused by alcohol abuse, use of certain drugs which are toxic to the liver, nutritional deficiencies, bile duct obstruction, autoimmune diseases, hepatitis, chemical exposure, heart and blood vessel disturbances, obstructed outflow of blood from liver, Budd-Chiari syndrome, alpha 1-antitrypsin deficiency, high blood tyrosine level at birth, glycogen storage disease, high blood galactose levels, cystic disease of the liver, diabetes, malnutrition, inherited condition involving the excessive accumulation of copper (Wilson's disease) or iron (hemochromatosis). Congenital liver abnormalities or defects may also be underlying causes of chronic liver disease
- Conditions that are most likely to cause liver disease in children are: galactosemia, Alagille's syndrome, alpha 1-trypsin deficiency, neonatal hepatitis, tyrosinemia, hemorrhagic telangiectasia, Reye's syndrome, Wilson's disease, thalassemia, biliary atresia, chronic active hepatitis and liver cancer
- The most common causes of liver diseases in adults are cirrhosis, type 1 glycogen storage disease and porphyria
- Risk factors for developing liver disease include excessive alcohol consumption, liver disease in members of the family and exposure to environmental toxins. Liver disease can also occur as a result of viruses such as hepatitis that can occur through intravenous drug use, multiple sexual partners, blood transfusions and travelling to other parts of the world or ingestion of contaminated food (risk of hepatitis A)
- Both prescribed and over-the-counter drugs can cause chronic liver disease and thus patient need to inform the health physicians of all the drugs they use. Even if the drugs may not be the cause, they may exacerbate liver symptoms. For example, food products such as Jamaican bush tea or Amanita phalloides mushrooms can cause liver disease. Prescribed drugs that can be involved with liver damage include isoniazid, methyldopa, chlorpromazine, methotrexate and amiodarone
Notes On Wrong Diagnosis Of Chronic liver disease
Wrong diagnosis of Chronic liver disease may be associated with the following:
- It may be difficult to determine the cause of chronic liver disease as some conditions such as Wilson's disease and viral hepatitis have a similar clinical presentation. Sometimes doctors will assume that patients are disguising the extent of their alcohol consumption and may misdiagnosis their Wilson's disease as alcoholic cirrhosis
- Chronic liver disease (especially Wilson's disease) can cause neurological symptoms such as speech problems, tremors or dystonia which may lead to the patient being misdiagnosed with neurological disorders such as essential tremor, Parkinsonism, ataxia or multiple sclerosis. Behavioural abnormalities (manic behaviour, emotional lability, depression, anger) may also occur as a result of some chronic liver conditions and patients may be misdiagnosed with conditions such as substance abuse or a mental disorder as a result
- Acute liver disease may have a similar presentation to chronic liver disease which can lead to misdiagnosis. For example, severe, acute alcoholic or viral hepatitis can mimic end-stage liver cirrhosis and be misdiagnosed as cirrhosis
- Tiredness and fatigue associated with liver disease may be misdiagnosed as a sleep disorder, depression or some other condition that causes fatigue
- The development of cirrhosis nodules as a result of liver cirrhosis may lead to a misdiagnosis of liver cancer
- Chronic liver disease (especially liver cirrhosis due to hepatitis) is often misdiagnosed or undiagnosed in children as they tend to have a different presentation to adults and are perhaps less able to communicate their symptoms. Children with liver cirrhosis tend to present with indigestion, abdominal bloating, loss of appetite, nausea, diarrhea and stomach pain. Some children may be misdiagnosed with a parasitic infection (e.g. biliary ascarid) and it is only when the anti-parasitic treatment fails to make a difference that further investigation is done
- The symptoms of a liver tumor or bile duct obstruction may produce symptoms and signs similar to fatty liver
- Most chronic liver condition present with similar symptoms so they are often misdiagnosed. This can be serious in certain cases such as patient's with Wilson's disease or hemochromatosis which can result in severe complications or even death if not treated adequately
- Often young patients with Wilson's disease have a decline in school work, mood problems, sexual exhibitionism, depression and psychosis but are referred to a psychologist or psychotherapist and the diagnosis of the underlying condition is further delayed
- Hemochromatosis may cause symptoms such as lethargy, muscle pain, fatigue, joint pain and personality changes which may lead to a wrong diagnosis of thyroid problems, chronic hepatitis, gall bladder disease, mental illness, alcoholic liver disease, depression, chronic fatigue syndrome or arthritis
- The differential diagnosis of liver disease due to hemochromatosis includes essential tremor, primary torsion dystonia, multiple sclerosis, Parkinson-Plus syndrome and Hallervorden-Spatz disease
Complications Of Misdiagnosis Of Chronic liver disease
The following may be complications of misdiagnosis of Chronic liver disease:
- Ascites are a relatively common complication of liver cirrhosis but may also be caused by nephrotic syndrome, protein-losing enteropathy, malnutrition, myxedema, ovarian tumors, pancreatic ascites, congestive heart failure, fungal and parasitic infections, sarcoidosis, systemic lupus erythematosus, tuberculous peritonitis, abdominal trauma and malignancy
- Diabetes may be overlooked as a complication of hemochromatosis
- Confusion, anxiety, depression, sleeping problems and anxiety due to hepatic encephalopathy which is a complication of liver cirrhosis may be misdiagnosed as a sleep disorder, anxiety, depression or some other psychiatric condition
- The differential diagnosis for hepatic encephalopathy (complication of chronic liver disease) includes intracranial lesions (e.g. bleeding or tumor), infection (e.g. abscess, encephalitis or meningitis), hypoglycemia, anoxia, uremia, electrolyte imbalance, hypercarbia, acute intoxication, alcohol withdrawal, organic brain syndrome or the toxic effect of drugs such as antidepressants, antipsychotics, sedative-hypnotics and salicylates
- Bleeding tendencies that occur as a complication of liver cirrhosis may be misdiagnosed as a blood disorder such as thrombocytopenia. Often, chronic liver disease can result in a reduced resistance to infections which may be misdiagnosed as an immunodeficiency disorder or be simply put down to the person not taking care of themselves adequately
- Fluid retention due to chronic liver disease may be dismissed as being an increase in weight due to inadequate exercise or poor diet
- Generalized muscle wasting may occur as a complication of chronic liver disease but it may be dismissed as normal weight loss or the result of aging
- Rare complications of Wilson's disease such as osteoarthritis and heart symptoms may lead to misdiagnosis of osteoarthritis or a heart condition
- Anemia due to chronic liver disease (especially in hemochromatosis) may also be caused by iron deficiency, sickle cell anemia, hemolysis, folate deficiency or poor diet
Other Notes On Misdiagnosis Of Chronic liver disease
- Conditions such as diabetes, gallstones and peptic ulcer disease are often associated with liver cirrhosis. Liver cirrhosis should at least be considered in patients who present with this condition in order to at least eliminate its presence. This is especially important because liver cirrhosis often has no symptoms in the early stages
General Misdiagnosis Articles
Read these general articles with an overview of misdiagnosis issues.
About misdiagnosis:
When checking for a misdiagnosis of Chronic liver disease
or confirming a diagnosis of Chronic liver disease,
it is useful to consider what other
medical conditions might be possible misdiagnoses or other alternative
conditions relevant to diagnosis.
These alternate diagnoses of Chronic liver disease may already have
been considered by your doctor or may need to be considered as possible
alternative diagnoses or candidates for misdiagnosis of Chronic liver disease.
For a general overview of misdiagnosis issues for all diseases,
see Overview of Misdiagnosis.
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