As there are over 100 diseases that can affect the liver, it isn’t surprising that there’s a wide variety of symptoms.
Not only are the symptoms varied, they also differ in intensity and severity from almost negligible to life-threatening.
Some liver problems can resolve themselves and leave no lasting damage. The liver can regenerate itself up to a point, but once cirrhosis (liver damage in which scar tissue replaces normal liver tissue) has set in, the damage to the liver is irreversible and symptoms are more severe.
People with chronic liver disease often don’t experience any symptoms – a fact that results in people sometimes only presenting with disease once it’s at quite an advanced stage.
Many of the symptoms – such as fatigue, diarrhoea, nausea, poor appetite, weakness and abdominal pain – are non-specific.
Therefore, people with liver disease might not notice them at first. These symptoms may also be confused with other conditions.
Fibrosis (initial and reversible scarring of the liver) often has no symptoms to start with. As a result, it’s often not diagnosed until it progresses. If it’s diagnosed early, and treated appropriately, the liver may heal itself and not develop cirrhosis. However, as the liver becomes less and less able to perform its functions, symptoms become more obvious and specific.
Symptoms may include:
- Jaundice. The whites of the eyes and skin can turn a yellow colour because of an excess of bilirubin in the system.
- Pain and swelling of the legs and abdomen, caused by fluid build-up.
- Enlarged spleen.
- Itchiness of the skin.
- Spiderlike blood vessels on the face and chest.
- Bleeding from the oesophagus and stomach.
- Blood abnormalities – specifically, a decreased number of red blood cells, white blood cells and platelets.
- Clotting problems. Bleeding and easy bruising can be the result of these abnormalities.
- Hormonal abnormalities. Decreased fertility in women and erectile dysfunction in men.
- Confusion. This is the result of a deterioration of brain function because of a build-up of toxic substances in the blood (a condition called “hepatic encephalopathy”).
- Severe encephalopathy can cause a marked, reduced level of consciousness with coma.
Liver failure is a serious condition that requires immediate hospitalisation. Many different conditions can lead to liver failure, which can develop either gradually or rapidly. A large portion of the liver must be damaged before liver failure occurs.
As the symptoms of liver problems are either absent in the early stages, or similar to the symptoms of many other conditions, liver disease and liver cancer are often only diagnosed in their advanced stages. It’s important to watch for warning signs that your liver may be in trouble.
Reviewed by Dr Mark Sonderup, B Pharm, MB ChB, FCP (SA). Senior Specialist, Division of Hepatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital. March 2018.