Chronic liver/hepatic disease  loss of normal structure and function of liver from a diffuse disorganisation and destruction of the normal liver structure by regenerative nodules surrounded by fibrotic tissue  alters structure and impairs blood and lymph flow.
Fourth leading cause of death in USA for those aged 35-55yrs

Unknown (~30%); alcoholic (~25-40%); HBV, HCV, HDV; hereditary metabolic diseases (eg haemochromatosis, Wilson’s disease); autoimmune (eg primary biliary cirrhosis, autoimmune hepatitis; SLE); drugs; biliary obstruction (eg cystic fibrosis, gallstones, tumour); diabetes mellitus; congestive heart failure

Main processes are inflammation and necrosis of liver cells when liver is continuously exposed to toxins  repair by fibrosis  regeneration, fibrous scar, nodules  distort surrounding tissues  problems with blood flow

Clinical features:
Vary considerable from person to person, but includes hepatomegaly; haematosis (most common presentation); jaundice; ascites; cyanosis; purpura; easy bruising; portal hypertension; pigmentation; digital clubbing
Insidious onset

Irreversible; cessation of alcohol or hepatotoxic drugs will halt progression
Management of underlying cause.
Care of nutritional status

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