Kidney, Liver, and Thyroid Health

What are the signs of liver disease?

The liver is a very hard-working organ with multiple roles, including helping with the digestion of food to convert the food to energy and filtering toxic substances out of the blood. So, when the liver isn’t functioning as well as it should, there can be a multitude of different symptoms.

Liver disease can be caused by various different things, such as hepatitis, autoimmune conditions, genetics, excess alcohol, obesity, and toxic chemicals or drugs (1). Hence, the symptoms of liver disease can vary, but there are also general symptoms that usually occur in all different types of liver disease. In this article, we will discuss those general symptoms.

Jaundice
In jaundice, the skin and whites of the eyes take on a yellow tinge. This is due to having too much bilirubin in the blood. Bilirubin is a yellow pigment that forms as part of the normal process of red blood cell recycling. Usually, bilirubin travels to the liver, where it binds to bile and is moved through the bile ducts into the digestive tract. It is then eliminated from the body predominantly in the stool but also in the urine. However, when the liver is not functioning properly, bilirubin accumulates in the blood and is deposited in the skin (2).

Dark urine
Dark urine can also be caused by too much bilirubin in the blood due to reduced liver function (2). However, it is important to note that the most common cause of dark urine is dehydration. Other abnormal urine causes include kidney injury, which can lead to bloody, or reddish-colored, urine. It is very important to see a doctor if you notice any bloody urine. 

Abnormal stools
Pale stools can occur if the bilirubin that is usually excreted in the stools is instead excreted in the urine (causing the dark urine mentioned above). This may be due to a blockage in the usual pathways or another problem preventing bilirubin from being eliminated in the stool (2).

Stools can also be bloody, and appear as bright red or black and tar-like stools. Bloody stools are usually caused by bleeding from varicose veins in the esophagus or stomach. These varicose veins can form from new veins that are created to bypass the liver and are very fragile and bleed easily (3).

Swelling in the abdomen
Liver disease can cause high blood pressure in the veins that bring blood to the liver. This can lead to an accumulation of protein-containing fluid in the abdomen, known as ascites. This ascitic fluid leaks from the surface of the liver and intestine, and also due to the leakage of albumin from blood vessels into the abdomen (4).

There may be no symptoms with only a small amount of fluid accumulation. However, increasing amounts can lead to weight gain, increased waist size, and discomfort. The pressure on the stomach can cause a loss of appetite, while pressure on the lungs can result in shortness of breath. Sometimes the excess fluid can also accumulate in the ankles, causing swollen ankles and lower legs. If a spontaneous bacterial infection occurs in the ascites, it can be fatal if left untreated (4).

Other disorders can also cause ascites, including cancer, kidney failure, heart failure, pancreatitis, and tuberculosis, but liver disease is the most common cause (4).

Nausea, loss of appetite, and fatigue
Most people with liver disease will eventually suffer from general symptoms, including nausea, loss of appetite, and fatigue (3). Various underlying causes can lead to these symptoms, such as fluid accumulation in the abdomen putting pressure on the stomach.

Itchiness
Severe itchiness is another symptom that affects some people with liver disease. It is more common in liver disease caused by autoimmune disorders and biliary obstructive diseases, which may occur due to stones or cancer. Drug-induced liver disease and liver damage due to viral hepatitis can also lead to itchy skin. However, it is rare in alcohol-induced liver disease and fatty liver disease (5).

There are various possible causes of itchy skin in relation to liver disease, including higher levels of bile salts and/or alkaline phosphatase, raised histamine levels, and varying levels of female sex hormones (6). Of course, itchy skin can also occur due to other health issues, such as psoriasis, eczema, allergic reactions, other internal diseases, and nerve disorders.

Easily bruised and abnormal bleeding
The liver is important for producing blood clotting factors; hence, when the liver is not functioning normally, there is a decreased ability to help injured blood vessels stop bleeding. This can result in more bruising than normal, prolonged bleeding after just minor cuts, and unexplained nose bleeds (7).

Liver disease is one of the most common causes of easy bleeding. Other causes can include severe platelet deficiency, anticoagulants to inhibit clotting (e.g. warfarin), and hemophilia (7).

Conclusions:
Other symptoms of liver disease are also possible and depend on the underlying cause of the liver disease. It is also important to note that many of the symptoms described in this article are not just specific to liver disease. An accurate diagnosis of liver disease requires a thorough doctor’s evaluation and blood tests to detect abnormal levels of specific blood components.

We offer a comprehensive Liver Health Panel to measure a broad range of proteins and enzymes in the blood, as well as individual tests for each of the tested components. These tests just require a simple finger-prick blood sample, which can easily be collected at home. However, we do recommend that you discuss your results with a healthcare provider.

References:
1. The Progression of Liver Disease. American Liver Foundation.
2. Tholey D. (2021) Jaundice in Adults. Merck Manual Consumer Version.
3. Tholey D. (2021) Liver Failure. Merck Manual Consumer Version.
4. Tholey D. (2021) Ascites. Merck Manual Consumer Version.
5. Hegade VS (2015). Itch and liver: management in primary care. Br J Gen Pract. 65(635): e418-e420.
6. Pietrangelo A (reviewed by Sethi S) (2019). What causes itching in liver disease and how to treat it. Healthline.
7. Moake JL (2020). Bruising and Bleeding. Merck Manual Consumer Version.