By Dr Ananya Mandal, MD
Liver is one of the most vital organs of the body. Liver disease may be short or long term.
Acute liver disease, or short term liver disease, manifests with severe symptoms that are recognizable.
However, long term liver damage, or chronic liver disease, often does not show symptoms unless much of the liver is damaged. It takes nearly two thirds of the liver to be damaged before there are symptoms of liver disease.
The liver also has a tremendous capacity to regenerate when damaged.
Classical symptoms of liver disease
Classical symptoms of liver disease are (1, 2, 3, 4) :–
- Nausea, vomiting – these are often the first and most non descriptive symptoms of liver disease. They are often ignored until the disease progresses further.
- Pain in the right upper part of the abdomen. This is where the liver is located so the pain and tenderness tends to concentrate in this region. Usually pain may result if there is enlargement of the liver. The pain is common in infective hepatitis. The pain may be severe in patients who have developed an abscess or boil over the liver due to infection. The pain is also excruciating in patients with bile duct obstruction called biliary colic. These patients need emergency care.
- Hepatomegaly – Swelling or enlargement of the liver that can be felt over the abdomen. Usually this in an initial finding. In patients with a scarred or shrunken liver like in cirrhosis the liver may not be enlarged but may be felt on examination as a hard organ.
- Jaundice leading to yellowish discoloration of the skin and whites of the eyes, nails and mucosal surfaces. This is caused by deposits of bilirubin or bile products that rise in the blood stream due to liver damage. Jaundice is one of the initial symptoms of liver disease and is commonly seen in infective hepatitis. It is also often the last to disappear.
- Liver disease also commonly begins with symptoms of weakness, fatigue, weight loss and loss of appetite. These are again non descriptive symptoms that are often disregarded till further progress of the disease.
Variation in liver disease symptoms
Since there is a wide range of causes of liver diseases, the symptoms also vary in specificity in different conditions.
Those with gall stones for example may develop abdominal pain especially after a fatty or greasy meal and may also develop fever if there is an infection.
Those with infective hepatitis usually present with fever and jaundice.
Symptoms of liver cirrhosis
Patients who have developed long standing liver damage and cirrhosis also develop severe and serious symptoms. These symptoms are also seen in patients with liver cancer that may be primary or from secondary metastasis.
Symptoms of liver cirrhosis include –
- Itching – this occurs due to deposits of bile salts under the skin
- Easy bruising – since there is shortage of clotting factors there may be a tendency of bleeding easily and bruising on slight impacts. The blood vessels just under the skin are also friable and easily breakable and give an appearance of spider webs especially over the chest.
- Imbalance of sex hormones leading to enlargement of breasts or gynecomastia in men. In some men this might also lead to impotence. This is usually seen over long term.
- Brain affliction – Ammonia is a waste product of the body that is filtered by the liver. As the liver fails the blood levels of ammonia rises. This may affect the brain in a condition called hepatic encephalopathy. This may lead to confusion and disorientation and ultimately coma if left untreated.
- Ascitis – accumulation of fluids in the abdomen. This leads to an enlarged and swollen belly.
- Muscle loss and wasting – this occurs due to the inability of the liver to provide the body with adequate nutrients like protein.
- Portal hypertension – this leads to increased pressure in the portal vein. This may lead to swollen veins and bleeding from the esophagus or rectum. The former manifests as blood-vomiting and the latter as bleeding via rectum in form of tarry black stools. (2)
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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