The liver is the body’s built-in detoxifier, and without it, we can’t function.
The large, football-shaped organ is located in the right, upper part of the abdomen under the rib cage. The liver plays a role in many bodily functions, including removing waste, facilitating digestion, filtering the blood, and ridding the body of toxins.
“Basically, anything we put in our body — medications, alcohol, supplements, everything — needs to go through the liver,” Dr Lisa Ganjhu, hepatologist and gastroenterologist at NYU Langone Health, tells TODAY.com.
Nutrients from food are metabolized by the liver into amino acids the body needs, for example, says Ganjhu. Liver enzymes break down alcohol and remove the toxins from the body.
The liver is the only internal organ that is regenerative, meaning it can repair itself or regrow damaged or lost tissue.
What causes liver disease?
“There’s a spectrum of liver disease, ranging from early stage reversible things to chronic issues to end-stage liver failure,” Dr. Shreya Sengupta, director of the Alcohol-Associated Liver Disease Program at Cleveland Clinic, tells TODAY.com.
Liver disease can be caused by genetics, autoimmune diseases, metabolic disorders, bile duct blockages, viruses (such as hepatitis), alcohol abuse and obesity, the experts note.
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Over time, liver disease can become chronic and lead to fibrosis, or a gradual stiffening of the liver due to buildup of scar tissue as the liver tries to repair itself from damage, per the Cleveland Clinic. Chronic liver disease can progress to severe and permanent scarring called cirrhosis, says Sengupta. “An even later stage is a failing liver or end-stage liver disease,” Sengupta adds.
Liver disease progresses gradually and often slowly — unlike acute liver failure, which can develop suddenly in a person without preexisting liver disease, the experts note.
Approximately 1.8% of adults in the United States (4.5 million people) have liver disease, and it causes about 57,000 deaths in the U.S. annually, according to the Cleveland Clinic.
What are the symptoms of liver problems?
The signs and symptoms of liver disease are not always obvious, especially in the early stages. That’s why the experts recommend everyone get routine checkups to screen for liver problems.
Metabolic panel test results are often the very first sign, says Ganjhu. “Abnormal liver enzymes are the most common reason that people come to a specialist,” Sengupta adds.
Liver disease can be reversible — and even in chronic or later stages, it’s possible to prevent further damage, which is why early detection is key, the experts note.
If you’re experiencing one or more of these symptoms, without any other known cause, talk to your doctor. While these may not be an indication of liver disease, it’s important to rule out serious causes.
Spider angiomas
One possible sign of liver disease is spider angiomas, says Sengupta. These vascular skin lesions look like small red or purple dots with tiny blood vessels branching out like spider legs, she adds.
They are painless and do not disappear. They often appear on the chest, stomach, back, face or arms.
Spider angiomas are common and often harmless — however, if you multiple of them, it could be a sign of an underlying problem. “Sometimes, these will be the earliest sign that something is going on with the liver,” says Sengupta.
Red palms
Another possible sign of liver issues on the skin is palmar erythma. “It’s a fancy way of saying your palms are red,” says Sengupta.
Palmar erythma is typically symmetrical, on the heel of both palms, and the rash is blanching, which means the redness disappears when pressure is applied.
“This can be a sign of hormonal dysfunction as a consequence of liver disease,” says Sengupta. It can also occur as a result other conditions, so talk to your doctor if you have concerns.
Itching with no rash
Itchy skin with no evidence of a rash (also called pruritus) can occur as a result of buildup of bile salts in the blood due to liver damage, Sengupta says.
“It often gets worse at night for whatever reason, so people will be fine all day, then when they go to bed, they can’t stop itching,” Sengupta adds.
While itching with no rash can be caused by other conditions, it could be a warning sign worth getting checked out. “Itching is often a symptom of more advanced liver cirrhosis,” says Ganjhu.
Muscle wasting
“Muscle loss can be an early sign of liver disease, it can be a medium sign, it can be a late sign — it can come at anytime,” says Sengupta. Muscle loss or wasting, aka sarcopenia, involves the loss of muscle mass or strength, which may occur with or without fat loss.
People may notice certain skeletal muscles, such as the triceps or quadriceps, are suddenly gone or much smaller than they were before, says Sengupta. In the context of liver disease, it often has to do with malnutrition. Studies have shown sarcopenia can affect between 20–70% of patients with cirrhosis.
Abdominal pain
Abdominal pain or discomfort, especially in the upper right side, can be a possible sign of liver disease. The liver itself does not have pain receptors, says Ganjhu, but liver disease can cause pain in the surrounding tissues in the abdomen.
Some people feel a dull ache or a sensation of heavy pressure, she adds. Isolated right rib pain here and there is usually nothing serious, but persistent, unexplained abdominal pain should never be brushed off, the experts say.
Disrupted sleep patterns
Another symptom Sengupta sees among patients with liver disease is sleep disturbances. “An early sign of liver disease is issues with your sleep — not just falling asleep or staying asleep, but going to bed later and later,” says Sengupta.
People with chronic liver disease may also wake up frequently throughout the night, have poorer sleep quality, or disrupted circadian rhythms, Sengupta adds. That said, these can also be caused by common sleep disorders or poor sleep hygiene, so it’s important to talk to your doctor.
Pale stools and dark urine
You’ll find another possible sign of liver problems in your toilet.
Bilirubin is a yellowish byproduct of broken down red blood cells, which passes through the liver and gets excreted into bile, per the Cleveland Clinic. The bile exits through the digestive tract and gives color to stool. In an unhealthy liver that can’t process bilirubin properly, it can build up in the blood and goes to the kidneys, where it’s excreted in urine, giving it a darker color. For that same reason, liver disease can cause lighter stools, says Sengupta.
Nausea and vomiting
Chronic nausea and vomiting are another possible sign of liver disease, the experts note. It may be accompanied by a loss of appetite and diarrhea, or other gastrointestinal distress.
“This one is tricky because it can also be so many other things, and it’s not that everybody with (nausea and vomiting) is going to have liver disease — the vast majority of people will not,” says Sengupta. “But it’s often the thing that brings people in to seek medical attention,” she adds.
Persistent fatigue
Unexplained fatigue or malaise (generally feeling unwell) is another possible early sign of liver disease, Sengupta notes. The fatigue may be mild, or persistent and debilitating.
In addition to feeling constantly tired, people may feel weaker than usual. If the fatigue is lasting and concerning, talk to your doctor.
Abdominal swelling
One symptom of liver disease is distension and swelling caused by a buildup of fluid in the abdomen, called ascites, says Ganjhu.
It’s often confused with bloating, a buildup of excess gas in the digestive tract, but unlike bloating, ascites occurs when there is an accumulation of fluid between the lining of the abdomen and the organs, Ganjhu adds.
Ascites can cause a painful swelling of the belly, which may need to be drained. “In the more advanced stages, people will say that all of a sudden, they look nine months pregnant,” says Sengupta.
Yellowing of the skin and whites of eyes
Jaundice, or the yellowing of the skin and the whites of the eyes, is a telltale sign that something is wrong with the liver, says Ganjhu.
It occurs when there is a buildup of bilirubin — which has a yellow hue — in the blood. Jaundice typically occurs with more advanced inflammation and scarring or cirrhosis, says Sengupta.
Jaundice may appear suddenly or develop gradually over time. “Worst case scenario, you’re yellow like a banana, but sometimes it’s just a yellow hint,” says Ganjhu. In any case, it’s a reason to go to the doctor ASAP.
Liver disease can be treated or cured
In addition to routine checkups, the experts encourage people to have open discussions with their doctor about alcohol or drug use. While liver disease can be deadly, it is also treatable and even curable depending on the type and stage.
Early diagnosis and treatment of liver disease can reverse liver disease, prevent further scarring and cirrhosis, or slow the progression of damage, says Sengupta. Treatment may involve medications, weight loss, abstinence from alcohol, and in severe cases, a liver transplant.
“Early treatment can delay worsening liver disease by decades,” says Sengupta.
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