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Signs and Symptoms of Various Liver Diseases

~ by Jo Jordan

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Continuously processing the blood used by your body, your liver strives to keep us healthy by neutralizing harmful toxins and wastes. It also converts food into substances needed for life and growth, storing energy, amino acids, protein, and manufacturing the enzymes and bile that help digest food.

So imagine what life would be like if your liver were compromised in some way...if it were to become diseased and suddenly it was unable to carry out its numerous functions? Would life even be possible? Well, no. Without a liver transplant, you would not survive for very long.

While the liver is capable of regenerating itself, its capacity to repair itself can be seriously impaired by repeated or extensive damage, so it’s important to take care of this vital organ.

Liver Disease: A Collection of Conditions
What Are the Symptoms...and the Solutions?

Liver disease is a collection of conditions, disorders, and infections that affect the cells, structures, and tissues of the liver, causing the organ to malfunction or stop functioning altogether.

The list of conditions includes the following. Click on the disease to review the list of symptoms.

• Acetaminophen toxicity
• Alcoholic liver disease
• Budd-Chiari syndrome
• Cancer
• Cirrhosis
• Cysts
• Fatty liver disease (NAFLD)
• Fibrosis
• Gilbert's syndrome
• Hemochromatosis
• Hepatitis
• Jaundice
• Primary biliary cirrhosis
• Primary sclerosing cholangitis (PSC)
• Wilson's disease

Do You Have Liver Disease?
Symptoms for the Most Common Liver Diseases.

1.  Acetaminophen Toxicity

The Journal of the American Medical Association (JAMA) reports that when given the maximum approved daily dosage of acetaminophen – a substance present in a range of common medications including Tavist Allergy/Sinus/Headache Caplets, Vicks DayQuil Multi-symptom Cold/Flu Relief Liquid, and Tylenol – test subjects developed early signs of possible liver damage.¹

Signs and Symptoms of Acetaminophen Toxicity

• Itchy skin
• Yellowing of your skin or the whites of your eyes
• Dark urine
• Upper right-sided abdominal tenderness
• Unexplained flu-like symptoms

Click here to read the complete Acetaminophen article.

2.  Alcoholic Liver Disease

In 2000, cirrhosis was one of the leading causes of death in the United States. Alcoholic liver disease usually develops after years of excessive alcohol intake. The longer the period during which alcohol is excessively consumed and the greater the amount ingested, the higher the likelihood of developing alcoholic liver disease.

Signs and Symptoms of Alcoholic Liver Disease

Symptoms are usually worse after an episode of heavy drinking, and tend to vary with the severity and progression of the disease. Sometimes symptoms do not present themselves until the disease is relatively advanced.

• Abdominal pain and tenderness
• Ascites (excess fluid between the membranes lining the abdomen and abdominal organs)
• Confusion
• Dry mouth / excessive thirst
• Fatigue
• Fever
• Jaundice
• Loss of appetite
• Nausea
• Weight gain due to ascites

• Abnormally dark or light skin
• Agitation
• Altered level of consciousness
• Bloody or dark, black, or tar-like bowel movements
• Breast development in males
• Difficulty concentrating
• Fluctuating moods
• Hallucinations
• Impaired judgment
• Impaired short- or long-term memory
• Light-headedness or fainting
• Paleness
• Rapid heart rate when rising to a standing position
• Redness on feet or hands
• Slow, sluggish, lethargic movement
• Vomiting blood or a sludge-like material

Click here to read the complete Alcoholic Liver Disease article.

3.  Primary Liver Cancer

Primary liver cancer generally remains undetected until it has reached the advanced stages because most people do not exhibit symptoms early on. By protecting yourself from cirrhosis and hepatitis – the two leading causes of the disease – you can greatly reduce your risk of developing liver cancer.

Signs and Symptoms of Primary Liver Cancer

• A yellow discoloration of the skin and whites of the eyes (jaundice)
• Abdominal pain, especially in the upper right part of the abdomen
• Abdominal swelling
• An enlarged liver
• General weakness and fatigue
• Loss of appetite
• Nausea and vomiting
• Weight loss

Click here to read the complete Primary Liver Cancer article.

4.  Liver Cirrhosis

Liver Cirrhosis is generally considered to be the 4th stage of Alcoholic Liver Disease, a progressive condition.

The most common cause of liver cirrhosis, chronic alcoholism accounts for approximately forty percent of the 26,000 people who die from the disease.² Cirrhosis is characterized by the replacement of healthy tissue with fibrous tissue, regenerative nodules, and liver scarring. The resulting hardening of the liver interferes with blood circulation, eventually leading to a complete loss of liver function.

Signs and Symptoms (and Complications) of Liver Cirrhosis

During the early stages, many people with cirrhosis experience no symptoms. However, as scar tissue replaces healthy cells, and liver function begins to fail, a person may experience a variety of symptoms and complications (*):

• Abdominal pain
• Abnormal accumulation of fluid in the abdominal cavity (ascites)
• Bleeding from engorged veins in your esophagus or intestines
• Dark, cola-colored urine
• Easy bruising
• Exhaustion
• Fatigue
• Gallstones *
• Insulin resistance and type 2 diabetes *
• Itchy hands and feet
• Lack of appetite
• Liver cancer *
• Liver failure *
• Loss of interest in sex
• Nausea
• Other system malfunctioning such as impotence, kidney dysfunction and failure, and osteoporosis *
• Portal hypertension (an increase in blood pressure in veins that carry blood from the abdominal organs to the liver) *
• Sensitivity to medications *
• Small, spider-like blood vessels under the skin
• Swelling of legs and feet from retained fluid (edema)
• Hepatic encephalopathy (toxins in the blood or brain – signs include forgetfulness, confusion, trouble concentrating; change in sleeping habits; behavioral, personality, and mood changes; and in advanced cases, delirium and coma) *
• Varix (an abnormally dilated or swollen vein, artery, or lymph vessel) *
• Weakness
• Weight loss
• Yellowing of skin and eyes (jaundice)

Click here to read the complete Liver Cirrhosis article.

5.  Liver Cysts

Also known as a hepatic cyst, a simple liver cyst is a thin-walled bubble, a fluid-filled cavity in the liver. A common condition, liver cysts are normally benign and pose no problems or health risks.

In some cases, however, liver cysts may grow large enough to cause pain or discomfort in the upper right part of the abdomen, liver enlargement, bile duct infection, or obstruction of the bile ducts, causing the cyst itself to become infected. In these cases, it is necessary to drain and/or remove the cyst.

Signs and Symptoms of Liver Cysts

• Liver cysts do no normally produce any signs or symptoms. They are sometimes detected by chance during other types of testing.

Click here to read the complete Liver Cysts article.

6.  Fatty Liver Disease (Non-Alcoholic Fatty Liver Disease – NAFLD)

Fatty Liver Disease (or steatosis) is generally considered to be the 1st stage of Alcoholic Liver Disease, a progressive condition.

The exact cause of NAFLD is unclear. Many researchers, however, believe that metabolic syndrome — a cluster of disorders that increase the risk of diabetes, heart disease, and stroke³ — plays a crucial role in the development of NAFLD.

NAFLD Levels of Severity

• Simple fatty liver (steatosis) – There are no symptoms.
• NASH (Non-alcoholic steatohepatitis) – Inflammation and signs of necrosis begin to appear. Eventually, scar tissue forms as more liver cell injury occurs.
• Cirrhosis – Liver scarring results in a hard liver that is unable to function properly. Cirrhosis can be fatal.

Signs and Symptoms of Fatty Liver Disease

You may have NAFLD without any signs or symptoms. If there are symptoms, they are normally vague and non-specific. In the early stages, you may experience fatigue, malaise, or a dull ache in your upper right abdomen.

At a more advanced stage of NAFLD, you may experience:

• Bleeding from engorged veins in your esophagus or intestines
• Fatigue
• Fluid in your abdominal cavity
• Itching of your hands and feet, and eventually your entire body
• Lack of appetite
• Liver failure
• Loss of interest in sex
• Mental confusion, such as forgetfulness or trouble concentrating
• Nausea
• Small, red spider veins under your skin, or easy bruising
• Swelling of your legs and feet from retained fluid
• Weakness
• Weight loss
• Yellowing of your skin and eyes and dark, cola-colored urine

Click here to read the complete Fatty Liver Disease article.

7.  Liver Fibrosis

Liver Fibrosis is generally considered to be the 3rd stage of Alcoholic Liver Disease, a progressive condition.

Liver fibrosis is characterized by the formation of fibroids or fibrous tissue, regenerative nodules, and liver scarring, all of which impede blood circulation, and lead to progressive loss of liver function.

Commonly caused by alcoholism and hepatitis C, cirrhosis is a degenerative disease of the liver.

Signs and Symptoms of Liver Fibrosis

• Abdominal pain
• Abnormal accumulation of fluid in the abdominal cavity (ascites)
• Bleeding from engorged veins in the esophagus or intestines
• Dark, cola-colored urine
• Easy bruising
• Exhaustion
• Fatigue
• Itchy hands and feet
• Lack of appetite
• Loss of interest in sex
• Nausea
• Small, spider-like blood vessels under the skin
• Swelling of legs and feet from retained fluid (edema)
• Tenderness and enlargement of the liver
• Weakness
• Weight loss
• Yellowing of skin and eyes (jaundice)

Click here to read the complete Liver Fibrosis article.

8.  Hepatitis

A gastroenterological disease, hepatitis means inflammation of the liver. Hepatitis is not one, but many diseases – Hepatitis A through E – in which the liver becomes inflamed, and its cells are damaged as a result of inflammatory chemicals being produced and released in the liver.

Signs and Symptoms of Hepatitis

The symptoms of various hepatitis forms are similar, the most noticeable being jaundice. As the viral infection spreads throughout the liver, the organ becomes enlarged, often causing abdominal pain.

• Abdominal pain
• Dark urine
• Diarrhea
• Enlarged liver
• Fatigue
• Fever
• General achiness
• Headache
• Jaundice
• Joint aches
• Loss of appetite
• Malaise
• Mild fever
• Vomiting two to three times per day, during the first five days

Some forms of hepatitis show very few symptoms, presenting only when longstanding inflammation has already led cirrhosis.

Note that Alcoholic Hepatitis (steatonecrosis or acute hepatitis) is generally considered to be the 2nd stage of Alcoholic Liver Disease, a progressive condition.

Click here to read the complete Hepatitis article.

9.  Primary Sclerosing Cholangitis (PSC)

Cholangitis is inflammation of the bile ducts of the liver. Sclerosing is inflammation that leads to the extensive formation of fibrous and scar tissue. In primary sclerosing cholangitis (PSC), the bile ducts inside and outside the liver have become inflamed and scarred.

Signs and Symptoms of PSC

Because PSC progresses slowly, the disease can be present for many years before symptoms appear. The predominant symptoms are,

• Bile duct infection (can cause chills and fever)
• Fatigue
• Intense itching
• Malabsorption (especially of fat) leading to decreased levels of the fat-soluble vitamins, A, D, E, and K.
• Severe jaundice (causing yellowing of the eyes and/or skin)
• Signs of cirrhosis
• Steatorrhea (a build-up of fat in stool, and loose, greasy, foul bowel movements)

Click here to read the complete PSC article.

10.  Jaundice

Jaundice is not a disease, but rather a symptom that can occur as a result of a variety of diseases. It appears as a yellowish discoloration of the skin and whites of the eyes (sclerae) caused by the abnormal buildup of bilirubin in the blood.

An orange-yellow pigment, bilirubin is part of bile; it forms in the liver as a byproduct of old blood cells. When there are too many red blood cells dying for the liver to cope with, yellow pigment builds up in the body resulting in jaundice.

The presence of jaundice is an indicator that a person is suffering from one of a variety of diseases including,

• Acetaminophen toxicity
• Alcoholic liver disease (alcoholic cirrhosis)
• Autoimmune hepatitis
• Biliary stricture (an abnormal narrowing of the biliary duct)
• Bilirubin processing disorders present at birth (Crigler-Najjar, Dubin-Johnson, Gilbert's, or Rotor's syndromes)
• Blocked bile ducts (caused by gallstones, infection, or tumors)
• Chronic active hepatitis
• Drug-induced cholestasis (bile pools in the gallbladder as a result of certain drugs)
• Drug-induced hepatitis
• Fatty liver disease (NAFLD)
• Hemolytic anemia
• Intrahepatic cholestasis of pregnancy (bile pools in the gallbladder because of the pressure in the abdomen during pregnancy)
• Ischemic hepatocellular jaundice (jaundice caused by inadequate oxygen or blood flow to the liver)
• Pancreatic cancer
• Primary biliary cirrhosis or sclerosing cholangitis
• Primary liver cancer
• Malaria
• Viral hepatitis (A, B, C, D, and E)

Click here to read the complete Jaundice article.

Liver Disease – What’s Next When You’ve Got Symptoms?

Once you’ve had an opportunity to consider the symptoms you’ve been experiencing, the next step is to educate yourself about the possibilities in terms of determining potential diseases. Remember, nobody knows your body better than you do.

An exploration of the various diseases will help you to decide whether or not you wish to pursue further testing. And education is doubly crucial because the more you know, the more face time your health care provider will be able to extend to you.

Testing will help to determine what the underlying issue is.

Types of Screening and Diagnosis

• Blood tests to measure bilirubin and electrolyte levels


• Computerized tomography (CT or CAT) scans take cross-sectional X-ray images of your internal organs


• Endoscopic retrograde cholangiopancreatography (ERCP) combines the use of X-rays and an endoscope (a long, flexible, lighted tube) to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas


• Magnetic resonance imaging (MRI) scans use magnetization and radio waves to produce images of the internal organs


• Stool tests to measure the amount of fat in feces


• Ultrasound (ultrasonography) is a non-invasive test using high-frequency sound wave technology to create an image of your liver

Other Types of Testing:

Elevated Liver Enzymes (Liver Blood Tests)

An elevated liver enzyme reading may be an indication of a liver disorder, damage to liver cells, or an obstruction to the biliary tract (also known as the gallbladder and bile ducts). Having elevated liver enzymes, however, is not an indication of a specific liver disease. It’s not uncommon to have elevated liver enzymes, but to determine the underlying cause, testing is necessary.

Liver Function Tests

Early detection of liver disease is vital to recovery, but often in the initial stages diseases of the liver result in very mild symptoms and, in some cases, none at all. Liver function tests can reveal an increased presence of certain enzymes, released by the liver when it is damaged. For this reason, in certain instances these tests are performed to detect, evaluate, and monitor liver disease or damage.

Liver Biopsy

A liver biopsy is performed to diagnose and monitor diseases that affect the liver and bile ducts. In most cases, a liver biopsy can provide a very specific diagnosis.

Normally performed under local anesthesia, this procedure involves the removal of a small sample of tissue from the liver. Several methods are used to obtain liver samples including laparoscopic liver biopsy, percutaneous image-guided liver biopsy, and open surgical liver biopsy. The sample is then examined under a microscope.

Liver Transplantation

A liver transplant, also known as hepatic transplant, provides the only chance of survival for someone whose liver has been destroyed by injury or illness. Transplantation surgery provides the organ recipient with a healthy liver so that the body can return to relatively normal functioning.

While transplant rejection and the life-long need for immunosuppressive drugs are serious considerations, liver transplantation prognosis is very good: Nationally, the overall patient survival rate one year post-surgery is over eighty-six percent, and almost seventy-eight percent after three years.⁴

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Notes:
1. Worst Pills Best Pills Newsletter: September 2006, “New Study Links Signs of Possible Liver Damage to Lower Doses of Acetaminophen (TYLENOL), Supporting Previous Research,” http://www.worstpills.org/member/newsletter.cfm?n_id=439 (accessed March 12, 2008).
2. The American Liver Foundation, “Cirrhosis,” http://www.liverfoundation.org/ (accessed November 26, 2007).
3. Mayo Foundation for Medical Education and Research (MFMER), “Nonalcoholic fatty liver disease,” http://mayoclinic.com/health/nonalcoholic-fatty-liver-disease/DS00577/DSECTION=3
4. University of California, San Francisco Medical Center, “The UCSF Liver Transplant Service Synopsis,” gidiv.ucsf.edu/gi/trhepservice.pdf (accessed November 2, 2007).
Staggering Statistic Notes
5. The National Hepatitis C Institute, “The Hepatitis C Awareness & Prevention Campaign,” http://www.nationalhepatitiscinstitute.org/Data/Transmission/CDCdeathrate2010.htm (accessed January 12, 2009).
6. American Liver Foundation, “Did You Know...? (Year End Statistics),” http://www.liverfoundation.org/chapters/heartland/news/309/ (accessed January 12, 2009).
7. Emory Healthcare, Emory Liver Transplant Center, “Disease Information,” http://www.emoryhealthcare.org/departments/Transplant/liver-transplant/disease_refer_phys.html (accessed January 12, 2009).