Symptoms of liver disease

Symptoms of Acute liver disease

Acute liver disease may be asymptomatic and without jaundice. Disease with symptoms is usually viral, produces generalized symptoms of malaise, anorexia and fever. Jaundice may appear as the disease progresses. There may be few signs other than jaundice and an enlarged liver. Jaundice is a yellow discoloration of the skin and mucous membranes and is best detected in the conjunctivae and sclera in day light. In the cholestatic stage of the disease, pale stools and dark urine are the features. Spider naevi and liver palms usually found in chronic disease but they can also sometimes found in severe acute disease.



Symptoms of Chronic liver disease

Patients with Chronic liver disease maybe asymptomatic or present with non specific symptoms, particularly fatigue. Few specific symptoms commonly encountered are:

#right hypochondrial pain (right side below the rib cage at the site of liver) due to liver distension
#abdominal distension due to ascites or, collection of fluid in the abdominal cavity.
#ankle swelling due to retention of fluid.
#haematemesis and melaena (blood vomiting and tarry black stool due to blood) from gastrointestinal haemorrhage
#pruritus (itching) due to cholestasis - this is often an early presentation of primary biliary cirrhosis.
#breast swelling (gynaecomastia), loss of libido and amenorrhoea because of endocrine dysfunction.
#confusion and drowsiness as a result of neuropsychiatric complications (portosystemic encephalopathy).


What is found on examination in chronic liver disease:

It may be so that the physical examination is normal in patients even with advanced chronic liver disease. The features usually found are as described below.


How skin looks in chronic liver disease:

The chest and upper body may show spider naevi. These are telangiectases that consist of a central arteriole with radiating small vessels. They are seen in the distribution of the superior vena cava (i.e. above the nipple line). spider naevi are sometimes a normal findings in pregnancy. In haemochromatosis the skin may look slate-grey in color. The hands sometimes show palmar erythema, which is a non specific change suggestive of a hyper dynamic circulation; it is also found in variety of condition where circulation is increased like pregnancy, thyrotoxicosis or rheumatoid arthritis. Clubbing, a swelling at nail beds sporadically occurs, and a Dupuytren's contracture is sometimes found in alcoholic cirrhosis. Xanthomas (cholesterol deposits) are found in the palmar creases or above the eyes in primary biliary cirrhosis.

Changes in the abdomen in chronic liver disease

Initial enlargement of liver will be followed by a small liver in well established cirrhosis. Enlarged spleen is seen with portal hypertension. Fluid in the abdominal cavity is also a feature of cirrhosis and portal hypertension.

Changes in the body in chronic liver disease due endocrine system dysfunction:

Gynaecomastia (swelling of breast in men) occasionally unilateral and testicular atrophy may be found in males.