The liver is a vital organ for detoxification, metabolism, and digestion. Several factors can affect the liver including a sedentary lifestyle, and dietary patterns which could trigger liver conditions that may progress into cirrhosis and liver failure. Experts point out that unlike most of the other health conditions, outward signs and symptoms of liver damage start manifesting only after it progresses into a critical state.
Dr Somashekhar Rao, consultant hepatologist and gastroenterologist, Apollo Hospitals, Jubilee Hills, Hyderabad, says, “Liver has a very good regenerative capacity and hence, we don’t see symptoms at an early stage. However, when the liver is damaged beyond its repairable capacity at that point of time, it slowly starts deteriorating and then liver tissues start becoming stiff and hard.”
“In early stages, liver disease can be managed through lifestyle management and treatment. However, if the liver disease goes to an advanced stage, (cirrhosis), it’s manageable, but not reversible,” says Dr Naveen Ganjoo, senior consultant, hepatology, and integrated liver care, Aster Hospital, Bangalore.
Signs and symptoms of liver damage
Experts list some common signs and symptoms of liver damage that often appear in those with liver disease.
1. Fatigue
“The most common symptom of liver disease is fatigue,” says Dr Ganjoo. People can experience fatigue, even at the earliest stages of liver injury, when the damage is not much. “Persistent fatigue and weakness can be a signal of compromised liver function,” he adds.
2. Jaundice
Jaundice is a yellowing of the skin and whites of the eyes due to abnormally high levels of bilirubin (bile pigment) in the bloodstream.
Dr Ganjoo says, “One of the most recognizable signs of liver damage is jaundice. This condition causes the skin and whites of the eyes to turn yellow.” This yellow color is caused by high levels of bilirubin (a yellow pigment formed from the breakdown of red blood cells) and may occur if the liver can’t efficiently process red blood cells as they break down.
3. Loss of appetite
“The liver plays a vital role in digestion, and when the liver is weak, or injured, whatever you eat does not get digested as it should. Due to this either you don’t feel hungry or are unable to eat,” says Dr Ganjoo.
He adds, “If someone is losing interest in food and cannot eat normally, this could be a sign of liver disease.” He continues that when the liver isn’t functioning properly, it can cause a decrease in appetite and ability to absorb nutrients from food.
4. Pruritus or itchy skin
Dr. Rao explains that “In cholestatic liver disease, bile excretion is slowed, and bile produced in the liver may not be adequately going inside the intestine, where the bile ducts are not functioning properly and are not able to excrete the bile properly.”
The bile is not being sent into the intestine through the normal route, and it goes into the blood from the liver. When this bile enters the blood, it causes itching all over the body, the reason for pruritus or itchy skin.
5. Dark urine
Dr Ganjoo says, “If the urine has turned dark or reddish, this could be an indication of liver problems. Dark urine is usually caused by the presence of bilirubin (a yellowish pigment), which occurs when the liver isn’t functioning properly to expel waste products.”
6. Abdominal pain
Dr Rao says, “Abdominal pain can happen when the liver becomes enlarged and there is pain on the upper right side of the abdomen, which can be caused due to liver injury.”
“The pain is mostly in the upper abdomen. It is not severe, but there will be continuous gnawing pain, which can be irritating. That is an early symptom of liver disease,” he adds.
7. Low sex drive
The liver plays an important part in regulating sexual hormones, however, when the liver is damaged or compromised, it can affect the sexual hormones in both males and females.
According to Dr Rao, “When there is cirrhosis of the liver for a prolonged period, the sexual hormones in males or females will be decreased affecting the sexual drive and fertility.”
8. Swelling of legs
Dr Rao says, “Swelling of the legs is one of the symptoms of chronic liver disease. Those with advanced (Cirrhosis) stage can experience swelling of the legs.”
He explains, “The liver produces albumin (protein) in our body, which maintains the oncotic pressure (the pressure to keep the blood inside the blood vessels). However, when the albumin is low, this fluid from the blood vessel seeps into the tissues and causes swelling.”
Tests for liver health
Dr Ganjoo says, “CBC (complete blood count) and liver function tests can be done to check for any liver disease. People with diabetes are at increased risk of liver problems and their Hb1ac levels are to be monitored too.”
Those with obesity, or long-term diabetes, are more prone to fatty liver. Dr Rao advises these people must get their liver function test, abdominal ultrasound, and FibroScan (which measures liver stiffness).
These three tests should be done at least once in six months. It can help identify liver disease at an early stage and diagnose it early before it progresses to irreversible damage of the liver. People should also be tested for Hepatitis B.
