hepatic and biliary disorders
Systemic Abnormalities in Liver Disease
Endocrine Abnormalities
Glucose intolerance, hyperinsulinism,insulinresistance, and hyperglucagonemia are often present in patients with cirrhosis; the elevatedinsulinlevels reflect decreased hepatic degradation rather than increased secretion, whereas the opposite is true for hyperglucagonemia. Abnormal thyroid function tests may reflect altered hepatic handling of thyroid hormones and changes in plasma-binding proteins rather than thyroid abnormalities. are common. Chronic liver disease commonly impairs menstruation and fertility. Males with cirrhosis, especially alcoholics, often have both Male Hypogonadism (including testicular atrophy, erectile dysfunction, decreased spermatogenesis) and feminization ( 