The liver is under the rib cage on the right side of the abdomen. It filters blood from the gastrointestinal tract, helps metabolize food, medications, and chemicals, removes toxins and waste products, and synthesizes essential proteins. This organ is remarkably capable of compensating when damaged. However, chronic liver damage that goes untreated can progress to liver failure. Causes of liver damage include excessive alcohol consumption, medications, viral infections, and autoimmune and genetic conditions.
A damaged liver has difficulty metabolizing fats and proteins from food. Bile production may slow down, making it difficult to deal with fatty meals. Also, if liver damage is chronic or severe, the vessels in the esophagus and stomach may dilate. In some cases, the dilated vessels may bleed, which is a medical emergency. People with chronic liver damage can also experience nausea, vomiting, and a distaste for meals high in fat and protein.
Liver damage can cause hormonal changes that in turn cause the dilation of small blood vessels. These spider veins are most noticeable on the face and torso. A blotchy redness of the facial skin, palms, and feet are common as well and are usually a result of hormone changes, vitamin deficiencies, or increased pressure in the vascular system. In advanced liver damage, jaundice can give the skin a yellow appearance. Jaundice happens when a waste product, bilirubin, builds up rather than being metabolized by the liver. Consistently high bilirubin can be a sign of acute or advanced liver disease. However, bilirubin can be elevated in other medical conditions as well.
A damaged liver has to work extra hard to perform its many functions. This may lead to fatigue or problems with concentration because the liver is filtering out toxins more slowly than normal. The liver may be sluggish in metabolizing food and struggle to absorb the nutrients required to maintain clarity and overall functioning. Advanced liver disease can lead to hepatic encephalopathy -- brain damage due to high levels of toxins in the body.
Even though a damaged liver can compensate or regenerate, the shape and size of the organ may change. These changes may result in a larger organ that in turn increases the size of the abdomen. Advanced liver disease or cirrhosis can also lead to swelling within the abdominal cavity or ascites. This swelling is due to decreased proteins in the blood that cause fluid to leave the vessels and collect in the abdomen and other body cavities. It's also caused by increased pressure in the vein that carries blood from the digestive organs to the liver.
When the liver struggles to perform, digestion can slow, and the body may try to compensate for increased toxins by excreting them in the bowels. This may cause constipation or diarrhea. In later stages of liver damage, the liver can no longer produce and process bile and bilirubin, which give stool its brown appearance. As a result, the stool becomes paler in color.
The inability of the liver to metabolize bilirubin and excrete it through the bowels can lead to a build-up of this waste material in the blood. The kidneys excrete the bilirubin that builds up in the blood, causing dark or tea-colored urine. Dark urine is a sign of a more acute liver issue and should prompt immediate medical attention.
The liver is responsible for creating proteins that help with blood clotting. A damaged liver has difficulty with this process, which leads to increased bruising or bleeding. A further complication can occur when new blood vessels are created to bypass the damaged organ. These vessels, often formed in the esophagus and stomach, begin to swell, leading to severe bleeding because these vessels are prone to rupture, especially if blood clotting factors are compromised. Vomiting blood and black stool are signs of bleeding in the esophagus or stomach and require immediate treatment.
Liver damage may cause fluid to build up in the ankles and legs. This build-up is due to a loss of blood protein which allows fluid to leak into the tissues. The legs and ankles are often affected because gravity pulls fluid down towards the feet. The late stages of liver damage can cause severe swelling.
A damaged liver has reduced blood flow due to liver damage and scarring. This creates pressure in the blood vessels surrounding the liver, causing portal hypertension. Compromised blood flow causes resistance. The body compensates by creating new blood vessels to get around the resistance. Sometimes these blood vessels bleed or rupture, which is a true medical emergency.
Active liver damage will show increased liver enzymes in the blood. These may not appear in all people with chronic liver conditions. Increased liver enzymes are a result of acute damage and can show that the organ is under attack from toxins, inflammation, viruses, or other causes. If elevated liver enzymes are present, doctors may investigate to determine the cause and prevent further damage.
Pruritus or itchy skin is a common sign of liver disease. This type of itching can be so severe that it affects sleep and daily activity. It appears without a rash or any other skin abnormalities and is not relieved by scratching. Itching can develop anywhere on the body, but it is most common on the palms of the hand and the soles of the feet.
Muscle wasting or sarcopenia increases the risk of mortality and other complications with some liver diseases, like cirrhosis. In people with cirrhosis, muscle wasting is complex, but a poor appetite and diet likely contribute significantly.
People with cirrhosis are in a state of accelerated starvation, where 10 hours of fasting (like most of us do overnight) affects them in the same way as three days of starvation would affect a healthy individual.
People with liver damage can experience multiple issues with brain function, including confusion or an altered mental state or, in severe cases, hepatic encephalopathy. When the liver is damaged, it cannot effectively remove toxins from the body. When these toxins build up in the blood, they can significantly affect brain function.
The type of bad breath associated with liver damage is called fector hepaticus. This sweet and musty odor results from high levels of toxins in the blood and may be a sign of hepatic encephalopathy. The only way to get rid of fector hepaticus is to cure the underlying disease; this can be difficult, as the symptom generally does not appear until there is already significant liver damage.
Sleep disturbances are prevalent in people with liver damage. One survey found that between 60 and 80 percent of people with liver cirrhosis and nearly half with hepatic encephalopathy report sleep issues. The exact cause has not been determined, but these sleep disturbances may result from delayed sleep onset, likely due to disruptions in melatonin levels.
Liver disease affects drug metabolism in many ways, increasing a person's sensitivity to medication. Changes in intestinal absorption affect liver blood flow, how fast the liver can remove the drug, and how well the kidneys are functioning.
The effects of different medications are unpredictable and do not correlate with liver test results, the type of liver injury, or the severity, so there are no straightforward dosage adjustments for people with liver disease.
Various types of liver disease can affect the nails. One study that set out to record new nail abnormalities in patients with liver disease found that 68 percent of study participants in the patient group had nail changes, compared to 35 percent in the control group.
The most common was a nail infection called onychomycosis. Other changes included longitudinal grooves, brittle nails, finger clubbing, and nails that were thick, deformed, or discolored.
Liver disease is one of the most common causes of an enlarged spleen. Conditions that affect the liver can result in portal hypertension, which is elevated blood pressure in the venous system that drains blood into the liver from the intestine, stomach, pancreas, and spleen.
Portal hypertension can cause pressure to build up and blood to pool, which can enlarge the spleen. An enlarged spleen may not have any symptoms but can cause decreased appetite or upper left-side abdominal pain that radiates to the back.
Some men show an increase in the amount of breast gland tissue due to an imbalance of estrogen and testosterone. This condition, called gynecomastia, is closely linked with liver damage. Liver injury can limit the degradation of estrogens in the body, leading to a sex hormone imbalance.
Additionally, gynecomastia is particularly common in people with alcohol-related liver disease, as ethanol inhibits testosterone production.
Malnutrition is yet another common symptom in people with liver damage. The liver plays a key role in regulating the nutritional state and maintaining the body’s energy balance. When the liver malfunctions, it often results in malnutrition.
Sometimes, this begins as a lack of appetite or frequent periods of nausea. People with alcoholic cirrhosis have a higher risk of nutritional problems. Additionally, malnutrition has links to liver complications and additional negative outcomes.
Liver conditions, particularly nonalcoholic fatty liver disease, have strong links to forms of impotence like erectile dysfunction. Liver damage can also cause a loss of sexual desire. While the mechanics of these symptoms require further study, many experts believe they stem from the sex hormone imbalances that are typical of liver conditions.
Alcohol also appears to play a role in the loss of sexual function, especially in males.
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