What are the first signs and symptoms of liver disease?
Chronic liver disease often won’t cause symptoms in the early stages. But sometimes it begins with an episode of acute hepatitis. For example, if you get a viral hepatitis infection, there’s an acute phase before the chronic phase sets in. You might have a fever, stomachache or nausea for a brief period while your immune system works to defeat the infection. If it doesn’t defeat it, it becomes a chronic infection.
Some other causes of liver disease might also begin with more acute symptoms or have occasional episodes of acute symptoms. Early symptoms of liver disease tend to be vague. They might include:
- Upper abdominal pain.
- Nausea or loss of appetite.
- Fatigue and malaise (feeling generally tired and ill).
What are the signs and symptoms of later-stage liver disease?
You might begin to notice more symptoms when your liver function begins to decline. This happens in the later stages of liver disease. One of the first side effects of declining liver function is that bile flow stalls in your biliary tract. Your liver no longer produces or delivers bile effectively to your small intestine. Instead, bile begins to leak into your bloodstream. This causes specific symptoms, including:
- Jaundice (yellow tint to the whites of your eyes and skin).
- Dark-colored pee (urine).
- Light-colored poop (stool).
- Digestive difficulties, especially with fats.
- Weight loss and muscle loss.
- Musty-smelling breath.
- Mild brain impairment (hepatic encephalopathy).
- Pruritus (itchy skin, but with no visible rash).
As liver disease advances, it can affect your blood flow, hormones and nutritional status. This can show up in various ways. You may see signs and symptoms in your skin and nails, such as:
- Spoon nails.
- Terry’s nails.
- Nail clubbing.
- Spider angiomas.
- Tiny red dots on your skin (petechiae).
- Small yellow bumps of fat deposits on your skin or eyelids.
- Easy bleeding and bruising.
- Red palms of your hands.
You may see signs of fluids leaking from your blood vessels and accumulating in your body, such as:
- Swollen abdomen (ascites).
- Swollen ankles, feet, hands and face (edema).
Liver disease symptoms in people assigned female at birth may include:
- Irregular periods (menstruation).
- Female infertility.
Liver disease symptoms in people assigned male at birth may include:
- Shrunken testicl*s.
- Enlarged male breast tissue.
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What are the complications of end-stage liver disease?
End-stage liver disease refers to decompensated cirrhosis and liver failure, when your liver has lost the ability to regenerate and is slowly declining. The most significant side effects of end-stage liver disease are portal hypertension and primary liver cancer (hepatocellular carcinoma). Complications of these two conditions are the leading causes of hospitalization and death in people with cirrhosis and liver failure.
Portal hypertension
Portal hypertension happens when scarring in your liver compresses the portal vein that runs through it. High blood pressure in the portal vein causes your body to divert blood flow to other veins connected with it, which become enlarged and stretched thin. These veins can leak, break and bleed. Internal bleeding from these varices can be sudden, severe and life-threatening.
Additional complications, though rare, include:
- Enlarged and overactive spleen (hypersplenism).
- Respiratory failure (hepatopulmonary syndrome).
- Kidney failure (hepatorenal syndrome).
Liver Cancer
While not everyone with chronic liver disease gets primary liver cancer (hepatocellular carcinoma), most people who do get liver cancer have chronic liver disease. The cycle of inflammation, repair and scarring changes your liver cells in ways that make them more likely to change into cancer. Healthcare providers also believe that chronic hepatitis viruses, in particular, may interfere with the DNA in your liver cells.
What are the causes of liver disease?
There are over 100 types of liver disease, but they fall into a handful of subtypes. Causes include:
- Viral infections. Viral hepatitis infections that become chronic can cause chronic hepatitis, including hepatitis B and hepatitis C.
- Alcohol-induced hepatitis. Heavy alcohol use can cause acute or chronic hepatitis. If it goes on long enough, it can cause cirrhosis and liver failure.
- Toxic hepatitis. Chronic overexposure to toxins, such as industrial chemicals or drugs, can cause acute or chronic hepatitis.
- Non-alcohol related fatty liver disease. Metabolic conditions associated with obesity, high blood sugar and high blood lipids can cause excess fat storage in your liver, which can cause inflammation (non-alcohol related steatohepatitis).
- Biliary stasis. Congenital (present at birth) conditions that obstruct or stall the flow of bile through your bile ducts can cause bile to build up and injure your liver, including biliary atresia and cystic fibrosis. Non-congenital causes include biliary stricture and gallstones.
- Autoimmune diseases. Autoimmune conditions can cause chronic inflammation and scarring in your liver or your bile ducts, including autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis.
- Inherited metabolic disorders. Disorders that cause toxic products to build up in your blood — such as glycogen storage disease (GSD), Wilson disease, hemochromatosis and Gaucher disease — can cause chronic liver damage.
- Cardiovascular diseases. Conditions that affect blood flow to and from your liver — including Budd-Chiari syndrome, ischemia, arterial diseases and right-sided heart failure — can cause chronic liver damage.
What are the risk factors for acquiring liver disease?
You may be more likely to get liver disease if you:
- Drink alcohol heavily.
- Use intravenous drugs.
- Use pain relievers like aspirin or acetaminophen
- Have metabolic syndrome.
- Are regularly exposed to toxic chemicals.
- Are regularly exposed to other people’s blood or body fluids.
