Symptoms of Liver Diseases

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Many patients can have nonspecific symptoms, such as fatigue, related to liver disease.  Unless liver disease is found in the differential diagnosis, it will take a long time to recognize the hepatic origin of these symptoms.  If patients present with no symptoms of liver disease, only when abnormal liver biochemistries are found during complete medical checkup or yearly physical examination, they know that they have liver disease.  When patients present with hepatic dysfunction, they can have symptoms of malaise, anorexia, fatigue, and weight change.

 

Although jaundice is the most typical manifestation of liver disease, patients may first notice lighter-colored stools or dark urine rather than scleral icterus.  When patients do not have these symptoms, jaundice may be caused by unconjugated hyperbilirubinemia due to hemolysis rather than intrinsic liver disease.

 

There are a variety of causes of abdominal pain related to liver disease.  When patients with symptomatic gallstones have a heavy meal, they can present with abrupt onset of severe right upper quadrant pain along with nausea and vomiting.  The patients often present with pain that is steady rather than colicky.  The pain can radiate widely to the chest and back.  The pain may not be alleviated even if patients change their posture.  The pain may last several hours.  When patients have persistent pain, particularly if accompanied by symptoms of weight loss and jaundice, the pain may indicate malignant bile duct obstruction.  Even if a patient does not have biliary tract disease, pain is present in parenchymal liver disease.  Many patients with chronic hepatocellular disorders, including chronic hepatitis C and nonalcoholic fatty liver disease present with vague right upper quadrant pain.  Severe abdominal pain may be frequently present in acute viral hepatitis, as well as in the hepatic congestion resulting from back pressure in heart failure or hepatic vein occlusion.

Patient with liver disease regardless of acute or chronic status can present with fatigue, anorexia, and malaise.  When patients have acute liver disorders such as acute viral hepatitis, drug-induced liver disease, or an acute presentation of autoimmune hepatitis, they may present with severe fatigue, nausea, and malaise accompanied by decreased appetite and resultant weight loss.  In chronic liver disease such as chronic hepatitis C, patients may complain of fatigue. 

 

Pruritus is frequently present in cholestatic disorders, such as primary biliary cirrhosis, sclerosing cholangitis, or cholestatic drug reactions, particularly when patients are clearly icteric.  Pruritus also occurs in patients with chronic parenchymal liver disease, in particular, chronic hepatitis C, and with acute viral hepatitis.

 

Easy bruising present in patients with liver disease suggests coagulopathy and thrombocytopenia.

 

Fever present in those with hepatic dysfunction including alcoholic hepatitis and drug-induced liver disease represents a prodrome of acute hepatitis A.  When patients present with suspected biliary obstruction, fever suggests complicating bacterial cholangitis or acute cholecystitis.

 

When liver disease patients have ascites, they can most frequently present with cirrhosis and portal hypertension.  If abdominal girth of patients increases, they may have presented with ankle edema.  When patients without liver disease have ascites, they may present a vascular disorder, such as hepatic vein occlusion, or a nonhepatic disease, such as nephrotic dysfunction or heart failure.  Lever disease patients with ascites suggest cirrhosis and it can complicate severe acute liver disease.

Hepatic encephalopathy in patients with liver disease can present with symptoms ranging from subtle cognitive impairment to deep coma.  Patients with hepatic encephalopathy can present with an early symptom of a disturbed sleep pattern with nocturnal insomnia and daytime somnolence.  When encephalopathy of patients advances, they can present with impaired memory, confusion, and difficulty completing routine tasks.  Since hepatic encephalopathy can cause gastrointestinal bleeding, bacterial infection, and electrolyte imbalance, these symptoms need to be excluded during the initial clinical evaluation.  When patients present with acute liver failure, it is impossible to distinguish coma owing to cerebral edema from advanced hepatic encephalopathy.  Cirrhosis causes varices formed in gastrointestinal tracts to abruptly and profusely bleed.

 

Gastrointestinal hemorrhage typically presents with hematemesis or melena.  Resultant postural hypotension and syncope can represent profound blood loss.  When protein load increases in the gut, hepatic encephalopathy is likely to result in.  When liver disease patients present with nonvariceal gastrointestinal bleeding, portal gastropathy is likely to occur.