What are some common liver disease symptoms?

When diagnosing liver disease, your health care provider looks at your symptoms and does a physical exam.

Some common signs and symptoms of liver disease include:

• A yellowing of the skin and eyes (jaundice).

• Gallstones (cholestasis).

• Enlarged liver.

• Portal hypertension. (This is increased pressure in the portal vein, which is a major vein that leads to the liver.)

• Esophageal varices. (This is enlarged or swollen veins in the lower part of the esophagus, which is the tube that carries food and liquid from the mouth to the stomach.)

• Internal bleeding caused by bleeding dilated veins (varices) in the esophagus, stomach, or intestines.

• Fluid buildup in the belly (ascites).

• Swelling in the lower legs, ankles, or feet (edema).

• Hepatic encephalopathy (a condition that occurs with severe liver disease and causes toxins to build-up in the blood. It can affect brain function).

• Liver failure.

• Bruising and bleeding easily.

• Abnormal bleeding.

• Severe itching.

• Feeling very tired (fatigue).

• Sexual problems from hypogonadism (low testosterone). This can cause:

  • Decreased libido and impotence in males with the loss of secondary sexual characteristics and feminization.

  • Problems with menstruation and infertility in females.

• Muscle cramps.

• Nail changes.

Your health care provider may want you to have a liver biopsy, liver function tests, or an ultrasound. They may also order a CT scan or MRI, an endoscopic retrograde cholangiopancreatogram (ERCP), or an endoscopic ultrasound (EUS). You also may have a Doppler scan to check blood flow in the hepatic portal vein. Your provider may also recommend elastography to check your liver for stiffness. Stiff areas in the liver are a sign of scar tissue (fibrosis) caused by liver disease.

What is jaundice?

Jaundice is a condition that causes yellowing of the skin and eyes. This occurs when you have very high levels of bile pigment (bilirubin) in the blood. This can happen because your body makes too much bilirubin or can't clear it from your body. Urine is often dark. This is because the bilirubin is removed from the body through the kidneys.

Sometimes the extra bilirubin and bile salts build up in the skin, leading to itching. High levels of bilirubin may be linked to inflammation, other problems of the liver cells, or blocked bile ducts. Sometimes jaundice is caused by the breakdown of a large number of red blood cells. This can happen in newborns. Jaundice is often the first sign of liver disease. It's sometimes the only sign.

What is cholestasis?

Cholestasis means any condition in which bile flow is slowed or stopped. Chole refers to bile, and stasis means not moving. Bile flow may be blocked inside the liver, outside the liver, or in both places. Symptoms may include:

• Jaundice.

• Dark urine.

• Pale stool.

• Easy bleeding.

• Itching. It is less at night and morning but gets worse throughout the day after having breakfast.

• Ascites.

• Chills.

• Pain from the bile ducts, gallbladder, or pancreas.

• Enlarged gallbladder.

• Nutritional deficiency caused by the body not absorbing fat and fat-soluble vitamins.

• Xanthomas. These are flat or slightly raised yellow skin deposits that are usually around the eyes.

Some causes of cholestasis include:

• Hepatitis.

• Alcoholic liver disease.

• Primary biliary cirrhosis.

• Medicine side effects of contraceptive pills, antibiotics, antithyroid drugs, and sulphonamides.

• Hormonal changes during pregnancy.

• A stone in the bile duct.

• Bile duct narrowing.

• Bile duct cancer.

• Pancreatic cancer.

• Inflammation of the pancreas (pancreatitis).

• Bacterial infections and sepsis.

What is liver enlargement?

Liver enlargement is often a sign of liver disease. But there are often no symptoms linked to a slightly enlarged liver (hepatomegaly). Symptoms of a very enlarged liver include belly discomfort or feeling full. As liver disease gets worse and cirrhosis develops, the liver shrinks because of scarring.

What is portal hypertension?

Portal hypertension is high blood pressure in the portal vein. This vein sends blood to the liver from the intestine and spleen. Portal hypertension may be from increased blood pressure in the portal blood vessels. Or it may be caused by the slowing of blood flow through the liver.

Portal hypertension can lead to the growth of new blood vessels (collateral blood vessels). These connect blood flow from the intestine to the general circulation. They bypass the liver. When this happens, substances that are normally removed by the liver pass into the general circulation. Symptoms of portal hypertension may include:

• Ascites.

• Esophageal varices.

• Vomiting blood.

• Black, tarry stools.

• Hepatic encephalopathy.

• Kidney problems or failure (hepatorenal syndrome).

• Enlarged spleen.

What are esophageal varices?

Esophageal varices are enlarged (dilated) veins in the lower part of the esophagus. They can bleed, which is dangerous because the bleeding can be fast and hard to stop. They can appear in people with severe liver disease. They are caused by portal hypertension. Over time, this pressure causes extra blood vessels (collateral blood vessels) to grow. They act as channels to redirect the blood under high pressure. The extra pressure in these vessels causes them to get larger. Over time, these vessels can reach the lower esophagus and stomach. They are likely to burst (rupture). The rupture can lead to major blood loss and sometimes even death. Symptoms of esophageal varices may include:

• Vomiting blood that looks like coffee grounds.

• Black, tarry, or dark bloody stools.

• Less urine output than normal.

• Extra thirst.

• Feeling lightheaded.

• Being pale.

• Low red blood cell count (anemia).

• Loss of appetite.

• Belly pain.

• Muscle cramps.

What is ascites?

Ascites is fluid buildup in the belly (abdominal) cavity. It's caused by fluid leaks from the surface of the liver and intestine. Ascites from liver disease often occurs with other liver disease symptoms, such as portal hypertension.

Symptoms of ascites may include a swollen belly, diarrhea, malnutrition, edema, nausea, enlarged lymph nodes, feeling full after eating a small amount of food, fevers, and night sweats. Ascities can cause mild pain and shortness of breath.

Causes of ascites may include:

• Liver cirrhosis, especially cirrhosis caused by alcoholism.

• Alcoholic hepatitis.

• Blocked hepatic vein.

Ascites can also be caused by other disorders not related to the liver, such as cancer, heart failure, tuberculosis, kidney disease, dialysis, and pancreatic disease.

Ascites can get infected. This is called spontaneous bacterial peritonitis.

What is hepatic encephalopathy?

Hepatic encephalopathy is harm to the brain and nervous system from toxic substances that build up in the blood. These toxins are normally removed by the liver. This problem can happen to people who have advanced liver problems. Hepatic encephalopathy is also called portal-systemic encephalopathy, liver encephalopathy, or hepatic coma.

Symptoms may include:

• An inverted sleep-wake pattern. This is when you sleep during the day and are awake throughout the night. This happens in the early stage of the condition.

• Impaired consciousness.

• Changes in logical thinking, personality, and behavior.

• Mood changes.

• Impaired judgment.

• Feeling sleepy.

• Confusion.

• Sluggish speech and movement.

• Being disoriented.

• Loss of consciousness.

• Coma.

• Seizures. (This is rare.)

• Muscle stiffness or tremors.

• Uncontrollable movement.

What is liver failure?

Liver failure is the severe breakdown of liver function. Liver failure happens when a large part of the liver is damaged from any type of liver disorder. Symptoms may include:

• Jaundice.

• Bruising or bleeding easily.

• Ascites.

• Impaired brain function.

• General failing health.

• Extreme tiredness (fatigue).

• Weakness.

• Nausea.

• Loss of appetite.

• Diarrhea.