Symptoms of Liver Damage

Multiple types of liver damage can cause ascites, which is a collection of fluid in the abdomen. The most common cause of ascites is portal hypertension or high blood pressure in the veins that bring blood to the liver. Small amounts of fluid generally do not have any symptoms.

Moderate amounts can lead to weight gain and increased waist size, while large quantities can cause significant swelling and discomfort. The skin on the abdomen can appear tight, and the navel may be pushed out or flat. This swelling can press against the stomach, leading to a loss of appetite. This pressure can also affect the lungs, making it difficult for the person to breathe or the veins in the abdomen, leading to swollen feet, ankles, and legs.

Pain is common in people with liver disease, affecting up to 82 percent of people with cirrhosis. Generally, the more advanced the liver disease, the more prevalent pain is. Pain can be dull, throbbing, tingling, or burning. While this pain is usually in the abdomen, liver disease can also cause referred pain in the neck, shoulders, and joints.

One of the roles of the liver is to break down bilirubin and remove it from the blood. Bilirubin is a yellowish pigment formed when the body breaks down red blood cells. Some bilirubin is excreted through the kidneys, but most of it travels through the blood to the liver, where it is excreted in bile and then passed into the digestive system for excretion. When the liver is damaged, it cannot process bilirubin quickly enough, so the pigment builds up in the blood and is deposited in the skin. This condition is called jaundice. Someone with jaundice has a yellowing of both the skin and the whites of the eyes.

Itchy skin or pruritis is a common symptom in cholestatic liver diseases, liver or gall bladder diseases that affect the bile ducts. Bile aids in digestion, draining from the liver into the bile ducts, intestines, and eventually back to the liver. The exact cause of pruritus is unknown, one of the most common being that bile salts build up under the skin, causing itch. Research has also found that the severity of itchiness has no relationship to the severity of the disease.

Changes in the urine are also related to jaundice. While the liver is responsible for removing most of the bilirubin from the body, some is excreted through the kidneys. When the liver is compromised, the kidneys start to eliminate more bilirubin, leading to dark yellow or brown urine.

Light or clay-colored stools often occur with jaundice. Dark-colored urine may also be present. When the liver no longer removes bilirubin effectively, it is no longer carried into the intestines by bile, so the stool no longer gets its typical dark brown color. People with liver disease may also experience constipation and diarrhea. Liver damage can cause clotting issues, too. If bleeding occurs in the esophagus, stomach, or upper GI tract, stool may look black and tarry if digested blood is present. Red blood in stool indicates bleeding lower in the GI tract.

Many factors can affect appetite in liver disease. It may be due to inflammation, ascites or distended abdomen putting pressure on the stomach, abdominal pain, bloating, disrupted glucose and insulin metabolism, muscle wasting, or cognitive changes. Food may no longer taste the same, or the person may develop nausea after eating.

Nausea and vomiting can occur when toxins start building up in the body due to liver damage and can be an early, non-specific system that something is not right. As the body's ability to eliminate toxins decreases, nausea, vomiting, and other forms of GI distress are likely to increase. 

The swollen abdomen and pressure caused by ascites can cause increased pressure in the abdomen. This pressure can affect the venous blood flow from the lower extremities, which can lead to edema in the feet, ankles, and legs. Edema can also occur because the liver can no longer produce enough albumin, a protein in the blood that prevents fluid from leaking into the tissues.

People with damage from liver disease can experience either weight loss or weight gain. Some people with liver damage may experience a loss of appetite due to pain, abdominal pressure from ascites, bloating, nausea, or changes in taste, which can result in weight loss. However, people with this condition can also appear to gain weight if they are experiencing ascites or edema because they are retaining more fluid than they would normally.

When people with liver damage lose weight, they lose fat and muscle. When they gain weight, it is typically due to excess fluid. People with liver damage may see slight weight fluctuation because they have lost a lot of fat and muscle but are retaining a significant amount of fluid. Even though the numbers on the scale may not change that significantly, the body's composition can change drastically.

Fatigue is a common symptom in people with chronic liver disease. When toxins accumulate, it can affect the brain, making the person feel tired, regardless of how much rest they get. Other factors that may contribute to fatigue with liver damage include disturbed sleep, reduced physical activity levels, and reduced tolerance to exercise.

Liver dysfunction can lead to clotting problems, specifically thrombocytopenia and hypoprothrombinemia. Thrombocytopenia is when the platelets in the blood (which form clots and stop bleeding) are low, and hypoprothrombinemia is a deficiency of prothrombin, a protein made in the liver that helps with blood clotting. When either occurs, people with liver dysfunction may notice that they bruise easily. They may have bruises that they do not know what caused them or get bruises that are much worse than expected.

Metal fog can be caused by hepatic encephalopathy, a brain disorder that occurs when toxins build up in the bloodstream due to liver dysfunction. Some forms of this condition are reversible; others are not. In addition to brain fog, symptoms can include personality changes, confusion, disorientation, and, in advanced stages, reduced consciousness.

At first, the person may experience disrupted sleep, sleeping during the day and staying awake at night. As the condition progresses, people may have increasing confusion and lethargy. In advanced stages, the person can fall into a coma, which can be fatal.

Spider-like blood vessels called spider angiomas may appear in people with liver dysfunction. These vessels may have a red dot in the center with reddish extensions that extend from the center. These angiomas disappear when pressure is applied but return when pressure is released. When someone with cirrhosis has spider angiomas, it can be indicative of extensive hepatic fibrosis. About 33 percent of people with cirrhosis get spider angiomas. Their exact cause is unknown, but they form due to a failure of the muscle surrounding the veins.

Diagnosis of liver disease begins with a physical exam and a thorough health history. The doctor will likely order blood labs called liver function tests to determine the extent of the damage, and they may do a biopsy by obtaining a tissue sample of the liver with a long needle and sending it to a lab for testing. Imaging, like a CT scan or MRI, may also be required. Finding the extent of liver damage and its cause determines treatment; generally, the earlier problems are detected, the better.

Treatment varies. Some liver problems can be treated with lifestyle changes, like not drinking alcohol or losing weight. Others will require surgery or medication and, in cases of liver failure, a liver transplant.

Multiple factors can increase the risk of liver dysfunction, including:

• Ongoing moderate or heavy alcohol consumption
• Having type 2 diabetes
• Having obesity
• Using shared needles to inject drugs
• Having tattoos or body piercings
• Having received a blood transfusion before 1992
• Having unprotected sex
• Coming into contact with blood and body fluids
• Having contact with toxins or chemicals
• Having a family history of liver disease

There are also some ways you can prevent liver dysfunction. These include:

• Choosing not to drink alcohol or drinking in moderation
• Avoiding risky behavior, like having unsafe sex and not sharing needles to inject drugs
• Getting vaccinated for hepatitis
• Being careful with medication
• Staying away from blood and body fluids
• Protecting your skin from chemicals
• Wearing a mask when using bug sprays, paint, and other chemicals
• Maintaining a healthy weight