In collaboration with Liver4Life.
Symptoms of liver disease can be difficult to spot, especially early on.
According to a recent study, an estimated 6% – 7% of the world’s population has liver fibrosis and doesn’t know it because they don’t have symptoms1. Often people remain unaware they have something wrong with their liver unless something is diagnosed during tests carried out for another reason. Any symptoms that do show tend to be non-specific and people often dismiss them as being caused by something else.
The speed that disease develops in the liver is different for everyone and is often down to the person’s predisposition and/or their genetic make up. While lifestyle has a role to play in the majority of liver disease in the UK, there are a number of autoimmune conditions that don’t, including Primary Biliary Cholangitis/Cirrhosis (PBC), autoimmune hepatitis (AIH)2.
As the liver becomes more irritated and inflamed, symptoms start to occur. The first stage of liver disease is fibrosis, which is the term used to describe mild scarring in the liver and occurs when the liver is repeatedly or continuously damaged or inflamed3. It is a condition that can be reversed if caught in the early stages and steps are taken to prevent further damage – like treatment and/or lifestyle changes.
Identifying and dealing with the cause can usually reverse early fibrosis. If damage is repeated or continuous (as occurs in chronic (long-term) hepatitis, liver cells will try to repair themselves, but the attempts may mean scar tissue occurs3.
Over a period of months and years, this cycle may cause more significant, advanced fibrosis can occur, which may then progress to cirrhosis.
Occasionally, people with fibrosis may experience:
- A dull or aching pain in the top right of the tummy (over the lower right side of the ribs). Patients usually characterise it as a persistent throbbing or stabbing pain4.
- Extreme tiredness (fatigue) and weakness: Researchers have noted that exhaustion and fatigue are the single most common symptom of liver damage. Unfortunately, the specific causes of liver disease-related fatigue and exhaustion are not fully understood. Researchers speculate that the root cause of liver disease-related chronic fatigue may be caused by changes in brain chemistry and hormone levels which result from impaired liver function. In particular, altered levels of corticotrophins, serotonin, and noradrenaline may be at the root of depleted energy levels. Researchers also note that fatigue-related symptoms are likely worsened by a general increase in the presence of toxic by-products in the blood, which the damaged liver cannot properly eliminate5.
- Unexplained weight loss and loss of appetite4. People tend to get noticeable symptoms as their liver becomes more severely damaged. As the condition progresses to cirrhosis2, they may also experience:
- Yellowing of the skin and whites of the eyes, also known as jaundice4: This yellowing of the skin and whites of the eyes are as a result of bilirubin (a bile pigment). Bilirubin builds-up in the blood and is unable to be eliminated as waste from the body.
- Vomiting or feeling sick (nausea) 4: persistent feelings of nausea arise from the body’s diminished ability to process and eliminate toxins, a well as changes in metabolism and digestion. Digestive issues, including indigestion and acid reflux can occur with liver damage, and may lead to vomiting attacks.
- Itchy skin4: Again, this relates to high bilirubin levels, and the liver not being able to process the bile. This lack of fluid flow most commonly shows on the surface of the skin in flaky, itchy patches.
- Stomach pain, or a swollen or bloated stomach4: As levels of albumin and proteins in the blood and fluid are retained, it may make people appear pregnant (a condition often referred to as ascites). While ascites can be caused by numerous medical conditions, cirrhosis of the liver is the single most common reason6.
- Dark yellow urine and/or dark, tarry-looking poo and diarrhoea4: Urine may become dark yellow and poo dark black due to increased levels of bilirubin in the body’s bloodstream, which the damaged liver is unable to eliminate via excretion through the kidneys.
- A tendency to bleed or bruise easily4: When the liver becomes damaged, it slows or entirely stops producing the proteins that are necessary for blood clotting, known as platelets.
- Swelling in the legs, ankles and feet caused by a build-up of fluid (oedema) 4: This occurs because impaired liver function inhibits the body’s ability to produce and circulate proteins, which in turn causes circulatory issues that are localised in the legs, feet and ankles because gravity naturally draws fluid down to the lower reaches of the body. Fluid retention can also be caused or worsened by decreased kidney function, which may accompany severe liver damage7.
- Personality changes, confusion, difficulty concentrating, memory loss, or hallucinations4: the liver is unable to filter blood normally and remove harmful substances from the bloodstream therefore toxins can build up and travel to the brain leading to confusion and memory loss, as well as mood changes, impaired judgment, disorientation, sluggish speech and movement, drowsiness and coma, this is sometimes referred to as Hepatic Encephalopathy8.
Other symptoms of severe liver damage may include:
- Fever and shivering attacks4
- Tiny red lines (blood capillaries) on the skin above waist level4
- Loss of sex drive (libido) 4
- Difficulty maintaining weight4
- In women, abnormal periods4
- In men, enlarged breasts, a swollen scrotum or shrunken testicles4
When to see a doctor?
Make an appointment with your doctor if you have any persistent signs or symptoms that worry you. Seek immediate medical attention if you have abdominal pain that is so severe that you can’t stay still
- Ginès, P., Graupera, I., et al. 2016. Screening for liver fibrosis in the general population: a call for action. V1, (3) P256-260, https://doi.org/10.1016/S2468-1253(16)30081-4 [Accessed 25 March 2018]
- Public Health England. Liver disease: applying All Our Health. https://www.gov.uk/government/publications/liver-disease-applying-all-our-health/liver-disease-applying-all-our-health [Accessed 23 Feb 2018]
- Ismani; Saudi J Gastroenterol. 2009 Jan; 15(1): 72–79.doi: 4103/1319-3767.45072. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702953/ [Accessed: 28 March 2018]
- NHS Choices. Cirrhosis. Symptoms. https://www.nhs.uk/conditions/cirrhosis/symptoms/ [Accessed 25 March 2018]
- Swain, M.G., Fatigue in liver disease: Pathophysiology and clinical management. Can J Gastroenterol. 2006 Mar; 20(3): 181–188.
- com. Ascites. Medical Author: Siamak N. Nabili, MD, MPH. https://www.medicinenet.com/ascites/article.htm [Accessed 25 March 2018]
- NHS Choices. Odema. https://www.nhs.uk/conditions/oedema/ [Accessed 25 March 2018]
- The Canadian Liver Foundation. Hepatic Encephalopathy. https://www.liver.ca/patients-caregivers/liver-diseases/hepatic-encephalopathy/ [Accessed 25 March 2018]