Common Symptoms of Liver Disease

What are some common liver disease symptoms?

When diagnosing liver disease, the healthcare provider looks at your symptoms and does a physical exam.

Some common liver disease symptoms include:

• A yellowing of the skin and eyes (jaundice)

• Cholestasis

• Liver enlargement

• Portal hypertension

• Esophageal varices

• Fluid buildup in the belly (ascites)

• Hepatic encephalopathy

• Liver failure

• Abnormal bleeding

• Severe itching

• Extreme tiredness (fatigue)

The provider may order a liver biopsy, liver function tests, an ultrasound, a CT scan or MRI, an endoscopic retrograde cholangiopancreatogram (ERCP), or an endoscopic ultrasound (EUS).

What is jaundice?

Jaundice is a yellow discoloration of the skin and eyes. This occurs when you have very high levels of bile pigment (bilirubin) in the blood. Urine is often dark because the bilirubin is sent out of the body through the kidneys. High levels of bilirubin may be linked to inflammation, other problems of the liver cells, or blocked bile ducts. Sometimes jaundice is caused by the breakdown of a large number of red blood cells. This can happen in newborns. Jaundice is often the first sign of liver disease. It is sometimes the only sign.

What is cholestasis?

Cholestasis means any condition in which bile flow is slowed or stopped. Chole refers to bile and stasis means not moving. Bile flow may be blocked inside the liver, outside the liver, or in both places. Symptoms may include:

• Jaundice

• Dark urine

• Pale stool

• Easy bleeding

• Itching

• Ascites 

• Chills

• Pain from the bile ducts, gallbladder, or pancreas

• Enlarged gallbladder

Some causes of cholestasis include:

• Hepatitis

• Alcoholic liver disease

• Primary biliary cirrhosis

• Medicine side effects

• Hormonal changes during pregnancy

• A stone in the bile duct

• Bile duct narrowing

• Bile duct cancer

• Pancreatic cancer

• Inflammation of the pancreas

What is liver enlargement?

Liver enlargement is often a sign of liver disease. But there are often no symptoms linked to a slightly enlarged liver (hepatomegaly). Symptoms of a very enlarged liver include belly discomfort or "feeling full." As liver disease gets worse and cirrhosis develops, the liver shrinks because of scarring.

What is portal hypertension?

Portal hypertension is high blood pressure in the portal vein. This vein sends blood to the liver from the intestine and spleen. Portal hypertension may be from increased blood pressure in the portal blood vessels. Or it may be caused by the slowing of blood flow through the liver. Portal hypertension can lead to the growth of new blood vessels (collateral blood vessels). These connect blood flow from the intestine to the general circulation. They bypass the liver. When this happens, substances that are normally removed by the liver pass into the general circulation. Symptoms of portal hypertension may include:

• Ascites

• Esophageal varices

• Hepatic encephalopathy

• Kidney problems or failure (hepatorenal syndrome)

• Enlarged spleen

What are esophageal varices?

Esophageal varices are enlarged (dilated) veins in the lower part of the esophagus. They are likely to bleed. They can appear in people with severe liver disease. They are caused by portal hypertension. This is high blood pressure in the portal vein that can occur when you have a diseased liver. The portal vein supplies the liver with blood. Over time, this pressure causes extra blood vessels (collateral blood vessels) to grow. They act as channels to redirect the blood under high pressure. The extra pressure in these vessels causes them to get larger. Over time these vessels can reach the lower esophagus and stomach. They are likely to burst (rupture). The rupture can lead to major blood loss from vomiting. Or you can lose blood through the digestive tract. Symptoms of esophageal varices may include:

• Painless vomiting of blood

• Black, tarry or bloody stools

• Less urine output that normal

• Extra thirst

• Light-headedness

• Paleness

• Low red blood cell count (anemia)

What is ascites?

Ascites is fluid buildup in the belly (abdominal) cavity caused by fluid leaks from the surface of the liver and intestine. Ascites from liver disease often occurs with other liver disease symptoms, such as portal hypertension. Symptoms of ascites may include a swollen belly. This causes mild pain and shortness of breath. Causes of ascites may include:

• Liver cirrhosis, especially cirrhosis caused by alcoholism

• Alcoholic hepatitis

• Blocked hepatic vein

Ascites can also be caused by nonliver disorders.

Ascites can get infected. This is called spontaneous bacterial peritonitis.

What is hepatic encephalopathy?

Hepatic encephalopathy means harm to the brain and nervous system. This occurs because of toxic substances building up in the blood. These toxins are normally removed by the liver. Hepatic encephalopathy is also called portal-systemic encephalopathy, liver encephalopathy, or hepatic coma. Symptoms may include:

• Impaired consciousness

• Changes in logical thinking, personality, and behavior

• Mood changes

• Impaired judgment

• Drowsiness

• Confusion

• Sluggish speech and movement

• Disorientation

• Loss of consciousness

• Coma

• Seizures (rare)

• Muscle stiffness or tremors

• Uncontrollable movement

What is liver failure?

Liver failure is severe breakdown of liver function. Liver failure happens when a large part of the liver is damaged from any type of liver disorder. Symptoms may include:

• Jaundice

• Tendency to bruise or bleed easily

• Ascites (see description above)

• Impaired brain function

• General failing health

• Extreme tiredness (fatigue)

• Weakness

• Nausea

• Loss of appetite

• Diarrhea