Symptoms of Liver Diseases

The liver is a large organ, located to the right of the abdominal cavity, responsible for several vital functions in our organism.

Liver diseases
Liver diseases

The liver can be affected by several different diseases, among the most common are hepatitis, cirrhosis, steatosis and cancer. Many of the liver diseases share common symptoms, because although they have different origins, they end up compromising the same functions of the liver.

In this text we will address the 12 most common signs and symptoms that patients with liver problems usually present. Are they:
  • 1. General and non-specific symptoms
  • 2. Tiredness
  • 3. Ascites
  • 4. Collateral circulation
  • 5. Gastrointestinal bleeding
  • 6. Encephalopathy
  • 7. Jaundice
  • 8. Purple spots on the skin
  • 9. Gynecomastia
  • 10. Teleangiectasias
  • 11. Erythema palmaris
  • 12. Abdominal pain

What is the liver?

The liver is a large organ located in the upper right quadrant of the abdomen just below the diaphragm.

The liver is a vital organ, responsible for numerous functions in our body. Among the roles that the liver exerts, we can mention the production of digestive enzymes, proteins, Coagulation factors, cholesterol, glucose and several other substances. The liver is also responsible for the metabolization of all nutrients absorbed by the intestines, as well as for the cleaning of circulating toxins.

By performing various functions in the body, liver diseases can present a wide variety of symptoms. Let's address below the 12 most typical signs and symptoms of liver problems, briefly explaining why they arise.

What is the portal vein?

Before we continue as an article, it is important to explain what the hepatic portal vein is, since most of the symptoms of liver disease are caused by an obstruction of this vein.

The portal vein, or hepatic portal system, is a large vein located at the entrance to the liver, responsible for draining blood from the gastrointestinal system. All blood from the stomach, spleen, pancreas, and intestines passes through the portal vein and through the liver before returning to the heart. In this way, any substance ingested and absorbed in the gastrointestinal tract must first pass through the liver before reaching the rest of the organism.

In cases of severe liver disease, especially in cirrhosis, the liver undergoes a process of fibrosis (scarring and stiffening of the liver tissue) that can cause portal vein obstruction, making it difficult for blood to enter the large vessel. The blood coming from the digestive organs must pass through the portal vein and through the liver before continuing its path towards the heart. If the portal vein is blocked, there will be a large blood congestion and an increase in pressure not only in the portal vein but also in all veins of the gastrointestinal tract. This picture is called portal hypertension and is responsible for several of the signs and symptoms that will be explained below.

Signs and symptoms

1. General Symptoms

Patients with liver lesions usually present a variety of general and nonspecific symptoms, which include nausea, loss of appetite, discouragement, and weight loss. In cases of acute hepatitis, the patient may also have a fever, which further contributes to the onset of this malaise.

A bitter taste in the mouth is a symptom popularly attributed to liver problems, but it is a very nonspecific complaint, which can be triggered by several other causes, such as reflux, gastritis, lesions of the teeth, lesions of the gingiva, infections of the pharynx or tonsils, dehydration, prolonged fasting, medication, cigarette... If the patient does not present any other symptoms, it is unlikely that the bitter mouth is a sign of a relevant liver problem.

2. Tiredness

A common symptom in any type of liver disease is fatigue or easy tiredness. This lack of energy affects patients with hepatitis, cirrhosis and even hepatic steatosis. The more advanced the lesion in the liver, the more inappetence the patient feels.

3. Ascites

Ascites is the name given to the accumulation of fluid inside the abdominal cavity, popularly known as water's belly. Ascites is a typical symptom of liver cirrhosis and often occurs when the patient has portal hypertension.

In addition to cirrhosis, schistosomiasis is another disease that usually affects the liver and causes portal hypertension and ascites.

Ascites arise because the blood is trapped and the high pressure inside the veins of the gastrointestinal tract causes a translocation of water out of the blood vessels, leading to fluid accumulation inside the abdominal cavity. It is as if the blood vessels begin to suck water.

Ascites is a typical manifestation of liver disease, but can also occur in diseases of other organs, such as decompensated heart failure and nephrotic syndrome.

4. Collateral circulation

When there is an obstruction to the passage of blood through the portal vein, the body needs to find another way for this blood to return to the heart. If the natural path is closed, it is necessary to arrange a detour; that's what the organism does. The blood begins to return in great quantity by collateral veins, that in healthy people only drain small volumes of blood.

The diversion of large amounts of blood to the collateral veins causes these to dilate, becoming very apparent upon examination of the abdomen. In the photo beside, there is the example of a patient with ascites and exuberant collateral circulation, two typical signs of portal hypertension.

5. Gastrointestinal bleeding

Obstruction of the portal vein causes an increase in pressure throughout the venous system of the digestive system, including the veins of the stomach and esophagus. This increased pressure causes varicose veins in these organs, facilitating the occurrence of bleeding.

Gastrointestinal bleeding from esophageal variceal bleeding is a typical manifestation of advanced cirrhosis of the liver. The patient suddenly presents with hemorrhagic vomiting and may lose large amounts of blood in these episodes.

Increased pressure in the digestive system also affects the veins of the intestines and rectum, causing an increase in the incidence of hemorrhoids and anal bleeding.

6. Encephalopathy

Encephalopathy is the name given to a dysfunction of basic brain functions. Hepatic encephalopathy, as the name implies, is the change in brain functions that occurs in patients with liver failure.

One of the goals of the hepatic portal system is to make every substance digested and absorbed in the digestive tract pass through the liver before proceeding to the rest of the bloodstream. Some substances that we ingest, mainly proteins of animal origin, are toxic and must be metabolized by the liver before they can be used by the body. In cases of portal hypertension, blood goes its way through the collateral veins and various toxic substances end up not being metabolized by the liver before they spread through the body.

In addition to portal hypertension, acute liver failure, such as in severe hepatitis, can cause acute liver failure, causing it to lose its ability to neutralize toxic substances.

Hepatic encephalopathy is the result of the action of these toxins on the brain. Depending on the degree of hepatic insufficiency or portal hypertension, the patient may present from light conditions, with lethargy, irritability and difficulty concentrating, to severe encephalopathy, with reduced level of consciousness and coma.

7. Jaundice

Jaundice is a name given to the yellowish coloring of the skin, eyes and mucous membranes, which arises due to the accumulation of bilirubin in the blood.

Bilirubin is a substance produced in the spleen from the destruction of old red blood cells. One role of the liver is to collect this bilirubin from the blood, metabolize it and excrete it into the biliary and intestinal passages, eliminated by the feces.

When the liver is diseased, it loses the ability to metabolize and/or eliminate the bilirubin that is constantly produced by the spleen. In this situation there is accumulation of bilirubin in the blood and deposition of excess in the skin, which causes the yellowish appearance of the same. Jaundice is often associated with itching, as bilirubin deposited on the skin causes irritation of the nerve endings.

Two other signs usually occur along with jaundice: light stools (fecal ache) and very dark urine. Bilirubin is responsible for the brown color of the stool. If for some reason bilirubin is not being excreted towards the intestines, the stool will no longer have its usual coloring, making it much clearer. Already the dark urine, Coca-Cola or Mate color, occurs by the filtration of excess bilirubin circulating in the blood through the kidneys, which ends up being excreted in the urine.

Several diseases of the liver can cause jaundice, the most common are hepatitis and cirrhosis. Jaundice can also occur in biliary disease, in infections such as malaria or leptospirosis, in cases of hemolysis (massive destruction of red blood cells) or by adverse reaction to some medicines.

Therefore, jaundice is a typical sign of liver disease, but it is not a sign of liver problems alone.

8. Purple spots on the skin

Patients with liver disease may be more likely to develop ecchymoses (purple spots on the skin) and bleeds after minor trauma. This is because the liver is responsible for the production of proteins that participate in the blood clotting system. Patients with liver disease may have coagulation deficiency, with bleeding more easily.

In addition to the deficiency of coagulation factors, which can occur in any situation of liver malfunction, patients with cirrhosis and portal hypertension often also have a low number of platelets, which is another factor that contributes to a greater difficulty in coagulating the blood.

9. Gynecomastia

Gynecomastia is the name given to the development of breasts in men. Male patients with cirrhosis often present with gynecomastia. The causes are not yet well understood, but it is believed that it is because of the elevated concentration of estrogen in the blood, which occurs both by increased production and by the reduction of the metabolism of this female hormone by the liver.

Another important factor for the onset of gynecomastia is the habitual use of the diuretic spironolactone, indicated in the treatment of ascites in patients with cirrhosis. One of the most common side effects of spironolactone is gynecomastia, which can occur even when used in patients without liver disease.

10. Teleangiectasias

Teleangiectasias, also called vascular spiders, are vascular lesions composed of a central arteriole surrounded by many small vessels. Teleangiectasias are most often found on the trunk, face and arms.

The origin of the spider veins is not completely uncovered, but it is believed that these lesions result from alterations in the metabolism of sex hormones, mainly estrogen.

Teleangiectasias are very common in cirrhosis, but they can also be seen during pregnancy or in healthy people. In these two cases the lesions are usually small and less than three. In cirrhosis, the more advanced the disease, the greater the size and number of vascular spiders present.

Erythema palmar is the name given to a very reddish palm, especially in the tenar and hypothenar regions (palm muscles), generally sparing the central parts of the palm. Palmar erythema is not a specific sign of liver disease, and may also be seen in patients with rheumatoid arthritis, hyperthyroidism, and in pregnant women.

12. Abdominal pain

Abdominal pain, located in the upper right quadrant, is a common symptom of liver disease, especially in acute hepatitis. It usually occurs by enlargement of the liver, which causes the hepatic capsule to rupture, a layer of secretion that covers the entire liver.

It should be noted that pain in the liver can also be caused by a number of other conditions, including problems with the gallbladder, bile ducts, right lung base and even damage to the ribs or abdominal muscles.

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