Liver Disease Symptoms

The various functions of the liver are carried out by the liver cells or hepatocytes. Currently, there is no artificial organ or device capable of emulating all the functions of the liver. Some functions can be emulated by liver dialysis, an experimental treatment for liver failure.

Each of the lobes is made up of lobules, a vein goes from the centre of each lobule which then joins to the hepatic vein to carry blood out from the liver. On the surface of the lobules there are ducts, veins and arteries that carry fluids to and from them.

Synthesis

1. A large part of amino acid synthesis
2. The liver performs several roles in carbohydrate metabolism:

* Gluconeogenesis (the synthesis of glucose from certain amino acids, lactate or glycerol)
* Glycogenolysis (the breakdown of glycogen into glucose)
* Glycogenesis (the formation of glycogen from glucose)(muscle tissues can also do this)

3. The liver is responsible for the mainstay of protein metabolism, synthesis as well as degradation
4. The liver also performs several roles in lipid metabolism:

* Cholesterol synthesis
* Lipogenesis, the production of triglycerides (fats).

5. The liver produces coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, as well as protein C, protein S and antithrombin.
6. In the first trimester fetus, the liver is the main site of red blood cell production. By the 32nd week of gestation, the bone marrow has almost completely taken over that task.
7. The liver produces and excretes bile (a greenish liquid) required for emulsifying fats. Some of the bile drains directly into the duodenum, and some is stored in the gallbladder.
8. The liver also produces insulin-like growth factor 1 (IGF-1), a polypeptide protein hormone that plays an important role in childhood growth and continues to have anabolic effects in adults.
9. The liver is a major site of thrombopoietin production. Thrombopoietin is a glycoprotein hormone that regulates the production of platelets by the bone marrow.

Liver Breakdown

• The breakdown of insulin and other hormones
• The liver breaks down hemoglobin, creating metabolites that are added to bile as pigment (bilirubin and biliverdin).
• The liver breaks down toxic substances and most medicinal products in a process called drug metabolism. This sometimes results in toxication, when the metabolite is more toxic than its precursor. Preferably, the toxins are conjugated to avail excretion in bile or urine.
• The liver converts ammonia to urea.

Liver Other Functions

• The liver stores a multitude of substances, including glucose (in the form of glycogen), vitamin A (1–2 years’ supply), vitamin D (1–4 months’ supply), vitamin B12, iron, and copper.
• The liver is responsible for immunological effects- the reticuloendothelial system of the liver contains many immunologically active cells, acting as a ’sieve’ for antigens carried to it via the portal system.
• The liver produces albumin, the major osmolar component of blood serum.

Diseases of the liver

Many diseases of the liver are accompanied by jaundice caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; normally, the liver removes bilirubin from the blood and excretes it through bile. There are also many pediatric liver diseases, including biliary atresia, alpha-1 antitrypsin deficiency, alagille syndrome, progressive familial intrahepatic cholestasis, and Langerhans cell histiocytosis to name but a few. Liver diseases may be diagnosed by liver function tests, for example, by production of acute phase proteins.

Liver Regeneration

The liver is the only internal human organ capable of natural regeneration of lost tissue; as little as 25% of a liver can regenerate into a whole liver. This is predominantly due to the hepatocytes re-entering the cell cycle. That is, the hepatocytes go from the quiescent G0 phase to the G1 phase and undergo mitosis. This process is activated by the p75 receptors. There is also some evidence of bipotential stem cells, called ovalocytes or hepatic oval cells, which are thought to reside in the canals of Hering. These cells can differentiate into either hepatocytes or cholangiocytes, the latter being the cells that line the bile ducts.

Liver Transplantation

Human liver transplants were first performed by Thomas Starzl in the United States and Roy Calne in Cambridge, England in 1963 and 1965 respectively. Liver transplantation is the only option for those with irreversible liver failure. Most transplants are done for chronic liver diseases leading to cirrhosis, such as chronic hepatitis C, alcoholism, autoimmune hepatitis, and many others. Less commonly, liver transplantation is done for fulminant hepatic failure, in which liver failure occurs over days to weeks.

Liver allografts for transplant usually come from non-living donors who have died from fatal brain injury. Living donor liver transplantation is a technique in which a portion of a living person’s liver is removed and used to replace the entire liver of the recipient. This was first performed in 1989 for pediatric liver transplantation. Only 20% of an adult’s liver (Couinaud segments 2 and 3) is needed to serve as a liver allograft for an infant or small child.

More recently, adult-to-adult liver transplantation has been done using the donor’s right hepatic lobe which amounts to 60% of the liver. Due to the ability of the liver to regenerate, both the donor and recipient end up with normal liver function if all goes well. This procedure is more controversial as it entails performing a much larger operation on the donor, and indeed there have been at least 2 donor deaths out of the first several hundred cases. A recent publication has addressed the problem of donor mortality, and at least 14 cases have been found. The risk of postoperative complications (and death) is far greater in right sided hepatectomy than left sided operations.

With the recent advances of non-invasive imaging, living liver donors usually have to undergo imaging examinations for liver anatomy to decide if the anatomy is feasible for donation. The evaluation is usually performed by multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI). MDCT is good in vascular anatomy and volumetry. MRI is used for biliary tree anatomy. Donors with very unusual vascular anatomy, which makes them unsuitable for donation, could be screened out to avoid unnecessary operations.

Liver diseases are damaged the function of hapetocytes, it may causes hepatocellular necrosis, fibrosis, and regeneration with nodule formation.

Chronic liver disease in which liver damage slowly by process and persisting over long time.It means it act as slow poison for healthy human body. It is characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occurs as a result of a process inwhich damage tissue is regenerated.It is already to progressive loss of liver function-cirrhosis is due to alcoholism, but in our population it is prohibited by people due religion, poverty and customs society, Hepatitis C, Hepatitis B virus are main role this dangerous disease in our population.

BASIC STRUCTURE OF LIVER:

“Liver is the largest gland in the body weighing about 1.4 k.g in an adult. It is situated under diaphragm in the upper abdomen cavity and is held in place by several ligaments.It is reddish-brown colour and comprise of four anatomical lobes.When viewed from the front the dominant left and right lobes can be seen which are separated by falciform ligament.Situated in a depression on the posterior surface of the liver in the gall bladder, a pear shaped sac which stores bile synthesis by the liver.The liver performs many metabolic functions. It has ability to store and metabolites useful substances such as nutrients,but it breakdown or detoxifying harmful substances to render then inert and less harmful”(Dr.viva Rolfe 2004)

“Liver weighing roughly 1.2-1.6 k.g performs many of the functions necessary for staying healthy. It is located in the right side of the body under the lower ribs and is divided into four lobes of unequal size. Two large vessels carry blood to the liver, the hepatic artery comes from heart and carries blood rich in nutrients absorbed from the small intestine. These vessels divided into smaller and smaller vessels, ending in capillaries. Each lobule is composed of hepatocytes, add, and remove substance from it. The blood then leaves the liver via the hepatic vein, returned to the heart, and is ready to be pumped to the rest of the blood.

Among the most important liver functions are:

• Removing and excreting body waste and hormones as well as drugs and foreign substances.
• Synthesizing plasma proteins, including those necessary for blood clotting,12 clotting factors are produced by the liver.
• Producing immune factors and removing bacteria helping body fight against infection.
• Producing bile to acid digestion.
• Excretion of bilurobin.
• Storing certain vitamins, minerals, and sugars.

Liver is an organ in vertebrates, including humans. It plays a major in metabolism and has a number of functions in the body including detoxification, glucagon storage and plasma proteins sythesis.I t also produces bile, which is important for digestion. It also starts in hepato or hepatic from Greek word for liver, hepar. Hepatocytes play main role in:

• Liver produces and excretes bile required for food, some of the drain directly into duodenum and some stored in gallbladder.
• Glyconeogensis (formation of glucose from certain aminoacid lactate or glycerol).
• Glyucogenolysis (the formation of glycogen from glucose).
• Breakdown of insulin and other hormones.
• Lipid metabolism, cholesterol synthesis, production of triglycerides.
• Liver produces coagulation factor, 1(fibrinogen) 11 (prothrombin) v, vii.ix, xi, as well as protein c and proteins and antithrombin.
• Liver converts ammonia into urea.

The liver is vulnerable to a wide of variety of metabolic, toxin, microbial, circulatory and neoplastic insults. The dominant primary diseases of the liver are viral hepatitis, alcoholic liver disease and hepatocellular carcinoma. More often, hepatic damage is secondary, to some of the most common diseases in humans, such as cardiac decompensation, disseminated cancer and extrahepatic function. There are following morphological changes in liver:

• Degeneration and intracellular accumulation damage from toxin or immunologic insult may cause swelling of hepatocytes.
• Necrosis and aptosis, any significant insult to the liver can cause hepatocytes necrosis, in aptosis cell death isolated hepatocytes round up to form shrunken, pykinolic, and intensity esinophilic cells containing fragmented nuclie.
• Inflammation –injury to the liver associated with an influx of acute and chronic inflammatory cells is termed hepatitis.
• Regeneration hepatocytes have long life spans and they proliferate in response to tissue resection or cell death.
• Fibrosis –fibrous tissue is formed in response to inflammation or direct to toxic insult to the liver, fibrosis points toward generally irreversible hepatic damage.

ETIOLOGY OF LIVER DISEASE.

There are following main causes of liver diseases, Hepatitis virus A, B, C, D, E.  Epstein-Barvirus, cytomegalovirus, yellowfever virus. Non-viral infection: leptospira, toxoplasma gendi, q fever, Poison-aflatoxin, carbantetrachloride,  mushrooms,  Drugs- paracetamol, halothane, alcohol, pergnancy, shock, wilson disease.

CLINICAL MANIFESTATIONS:

SYMPTOMS: anorexia, malaise, fever, jaundice, right abdomenal pain, hepatomegaly, ginecomastia, pruritus, hematamesis, confusions.

SIGNS: jaundice, hepatomegaly, pale stool, dark colored urine, palmer erythema, clubbing,  spleenomegaly, testicular atrophy, ginecomastia, with other complications – colateralveins peripheral edema, ascites.

TESTS FOR LIVER DISEASES:

The diagnosis of liver diseases depends upon a combination of history, physical examination, labortary testing and sometime radiological studies and biopsy.

• Alanine aminotranferase: ALT is enzyme produced In hepatocytes, the major cell type in the liver. All types of hepatitis (viral, alcoholic, drug induced etc) cause hepatocyte damage that can lead to elevation in the serum ALT activity.
• Aspartate aminotransferase: AST similar to ALT but less specific for liver disease as it is also produced in muscle and can be elevated in other condition (heart attack). Alcoholic hepatitis and viral hepatitis may it.
• Alkaline phosphatase: It is an enzyme, produced in bileducts, intestine, kidneys, placenta and bone.It is elevated in case chronic liver diseases.
• Gamma glutamyl tranferase: It is an enzyme produced in bile duct, in alcohalism and biliary disease it is elevated.
• Bilirubin: Bilurubin is the major breakdown that results from the destruction of old blood cells. It is removed from the body by the liver, chemically modified by process call conjugation, secreted into bile passed into intestine and some extent reabsorbed by intestine. In chronic liver disease, acquired liver diseases, the serum biliurubin is elevated.
• Albumin: Many factors necessary for blood clotting are made in liver. When liver function is impaired, their synthesis and secretion into blood is decreased. In chronic liver disease, it highly elevated.
• Platelets count: These are smallest blood cells in liver disease, spleen becomes large, blood flow through liver is impaired platelets are fallen from normal.
• Serum protein electrophoresis: In cirrohosis, the albumin may decreased and the gamma- globulin can be significantly elevated.

Chronic liver disease is marked by gradual destruction of liver tissue overtime. It is seventh leading cause of death in United States, according to National Institute of Diabetes and Digestive and Kidneys disease becaudse of chronic damage to the liver, scar tissue slowly replaces normal functioning liver tissue, as the normal liver is lost, nutrients, hormones, drugs, and poisons,are not processed effectively by the liver. In addition, protein production and other substances produced by the liver are inhibited.

Liver disease can be caused by a variety of factors. Causes include:

• congenital birth defects, or abnormalities of the liver present at birth
• metabolic disorders, or defects in basic body processes
• viral or bacterial infections
• alcohol or poisoning by toxins
• certain medications that are toxic to the liver
• nutritional deficiencies
• trauma, or injury

Liver diseases most likely to be seen in children include:

• galactosemia, an inherited disease in which the body can not tolerate certain sugars in milk. These sugars can build up, causing serious damage to the liver and other organs of the body.
• Alagille’s syndrome, a condition in which the bile ducts narrow and deteriorate, especially during the first year of life
• alpha 1- antitrypsin deficiency, a genetic liver disease in children that can lead to hepatitis and cirrhosis of the liver
• neonatal hepatitis, which is hepatitis that occurs in a newborn during the first few months of life
• tyrosinemia, a disorder that causes serious problems with liver metabolism
• hemorrhagic telangiectasia, a condition in which thin blood vessels allow frequent and easy bleeding of the skin and digestive tract
• Reye’s syndrome, a condition that causes a buildup of fat in the liver. This condition has been linked in some cases to use of aspirin, especially in conjunction with chickenpox, influenza, or other illnesses with fever.
• Wilson’s disease, an inherited condition that causes a buildup of the mineral copper in the liver
• thalassemia, a group of hereditary anemias, or low red blood cell counts
• biliary atresia, a condition in which the bile ducts extending from the liver to the intestine are too small in diameter or are missing
• chronic active hepatitis, an inflammation of the liver that causes severe scarring and interference with liver function
• cancer of the liver, which may result from cancer in other parts of the body that have spread to the liver

Liver diseases most likely to be seen in adults include:

• cirrhosis, which is a serious condition that causes tissues and cells in the liver to be replaced by scar tissue.
• type I glycogen storage disease, which causes problems in controlling blood sugars when a person fasts
• porphyria, a condition that causes a malfunction in how the body uses porphyrins.

Porphyrins are important in making hemoglobin in red blood cells, to carry oxygen throughout the body.

• hemochromatosis, a condition which causes the body to absorb and store too much iron. The iron buildup causes damage to the liver and other organs.
• primary sclerosing cholangitis, a condition that causes the bile ducts of the liver to narrow due to inflammation and scarring
• sarcoidosis, a disease that causes a buildup of lesions within the liver and other organs of the body
• gallstones, which may block the bile duct
• hepatitis, an inflammation and infection of the liver caused by any of several viruses
• cystic disease of the liver, which causes lesions and fluid-filled masses in the liver

Alcohol-related liver diseases include:

• fatty liver disease, which causes an enlarged liver
• alcoholic hepatitis
• alcoholic cirrhosis

What can be done to prevent the disease?
Some, but not all, liver diseases can be prevented. For example, hepatitis A and hepatitis B can be prevented with vaccines.

Other ways to decrease the risk of infectious liver disease include:

• practicing good hygiene, such as washing hands well after using the restroom or changing diapers
• avoiding drinking or using tap water when traveling internationally
• avoiding illegal drug use, especially sharing injection equipment
• practicing safest sex. Practicing safer sex provides less protection.
• avoiding the sharing of personal hygiene items, such as razors or nail clippers
• avoiding toxic substances and excess alcohol consumption
• using medications only as directed
• using caution around industrial chemicals
• eating a well balanced diet following the food guide pyramid
• getting an injection of immune globulin after exposure to hepatitis A
• using recommended safety precautions in healthcare and day care work

How is the disease diagnosed?
A healthcare professional can determine whether a person’s symptoms, medical history, and physical exam are consistent with liver disease. Hepatomegaly, an enlarged, firm liver, and other signs of liver disease may be found on examination.

Many further tests may also be used to support the diagnosis. These include blood tests, such as:

• liver function tests, which are blood tests that check a wide variety of liver enzymes and byproducts
• a complete blood count (CBC), which looks at the type and number of blood cells in the body
• abdominal X-rays
• ultrasounds, to show size of abdominal organs and the presence of masses
• an upper GI study, which can detect abnormalities in the esophagus caused by liver disease
• liver scans with radiotagged substances to show changes in the liver structure
• ERCP, or endoscopic retrograde cholangiopancreatography. A thin tube called an endoscope is used to view various structures in and around the liver.
• abdominal CT scan or abdominal MRI, which provide more information about the liver structure and function

In some cases, the only way to definitively diagnose the presence of certain liver diseases is by a liver biopsy. This procedure involves the removal of a tiny piece of liver tissue for examination under a microscope. Liver biopsies may have to be done repeatedly to see how the disease is progressing or responding to treatment.

What are the long-term effects of the disease?
Long- term effects depend on the type of liver disease present. For example, chronic hepatitis can lead to:

• cirrhosis of the liver
• liver failure
• illnesses in other parts of the body, such as kidney damage or low blood counts

Other long-term effects of liver disease may include:

• gastrointestinal bleeding. This includes bleeding esophageal varices, which are abnormally enlarged veins in the esophagus and/or the stomach.
• encephalopathy, which is deteriorating brain function that may progress to a coma
• peptic ulcers, which erode the stomach lining
• liver cancer

What are the risks to others?
Some liver diseases are highly contagious and pose a risk to others. For example, different forms of hepatitis are highly contagious through sexual contact or contamination of food and water. Other liver diseases are not contagious, such as biliary atresia.

What are the treatments for the disease?
Treatment for liver disease will include:

• bed rest
• drinking extra fluids to prevent dehydration
• avoiding unnecessary medications
• avoiding alcohol
• eating a well balanced diet for liver disease
• taking antinausea medications as needed

Further treatment will depend on the type and the extent of disease. For example, treating hepatitis B, hepatitis C, and hepatitis D may involve the use of medications such as the antiviral medication alpha interferon. Other medications used to treat liver disease may include ribavirin, lamivudine, steroids, and antibiotics.

To treat Wilson’s disease, the healthcare professional may prescribe trientine or penicillamine. If these medications cannot be tolerated, the person may be asked to take zinc acetate.

Hemochromatosis is treated by removing a pint of blood once or twice a week for several months to a year, depending on the severity of the condition. This will effectively deplete the excess iron.

Vitamin and mineral supplements are given to prevent complications from primary biliary cirrhosis. These include vitamin A, vitamin D, vitamin E, vitamin K, and calcium. Cholestyramine may be given to help relieve itching.

Biliary atresia may be treated with a procedure called the Kasai surgery, a procedure in which the surgeon replaces the bile ducts with part of the baby’s intestine.

Acute fulminant hepatitis can cause life-threatening liver failure. This requires a hospital stay and treatment for the bleeding disorder, encephalopathy, and nutritional problems. Sometimes, the only effective treatment for certain liver diseases is a liver transplant.

What are the side effects of the treatments?
Side effects will depend on the treatments used for the liver disease. Antibiotics may cause stomach upset or allergic reactions. Side effects of interferon include a flu-like illness, withfever, and body aches.

A liver transplant can cause many complications, including failure or rejection of the new liver. After a liver transplant, a person will need to take powerful anti-rejection medications for the rest of his or her life. Because these medications interfere with normal immunes system functioning, they increase the person’s risk for infections and certain types of cancer.

What happens after treatment for the disease?
What occurs after treatment will depend on the type of liver disease and the response to treatment. For example, people with hepatitis A will not usually need medication after the disease has been resolved. They can return to a normal lifestyle when symptoms are gone, even if they still have some jaundice.

A person with hepatitis B, hepatitis C, or hepatitis D needs to be monitored for side effects and benefits during and after interferon treatment. Alpha interferon treatment might be repeated if the disease flares up again. A person who has received a liver transplant is checked for further disease, as well as for function of the new liver.

How is the disease monitored?
Monitoring will depend on the type of liver disease. Liver function tests may be performed during periodic visits to the healthcare professional, to monitor the disease and to see how the liver is working. Any new or worsening symptoms should be reported to the healthcare professional. The status of the liver may require repeated liver biopsies. Decisions for further treatment or liver transplantation are frequently made based on these tests.

iver disease symptoms can be very subtle and/or very obtuse. This is a partial list. If you suspect that you may have liver disease please see a qualified health care physician.

Liver Disease Symptom 1 – Jaundice

Be it a disease of the gall bladder or liver itself, jaundice is one of the main symptoms of liver disease. If the skin becomes jaundiced, then we know that there is most likely an issue with the Liver or Gall Bladder. Jaundice can either turn the skin yellow or orange depending on the type. With this, the whites of the eyes often take on a yellow color as well. Jaundice is the result of the liver not properly breaking down old blood and transforming it into bile. When Jaundice is quick to set in and is accompanied by flu like symptoms, it is important to be seen by a medical doctor to identify if the jaundice is being caused by acute hepatitis or severe infection in the gall bladder. For more information about hepatitis symptoms, visit our hepatitis symptoms list.

According to Traditional Oriental Medicine, there are two types of Jaundice, Yin Jaundice and Yang Jaundice:

1. Yang Jaundice: Whole-Body jaundice with color that resembles a ?fresh tangerine,? slight abdominal distention, constipation, possible palpitations, urinary difficulty, thirst (with the ability to take only sips), and a yellow-greasy tongue coating. This type of jaundice in Oriental Medicine is from what is described as excess damp heat.
2. Yin Jaundice: Dull yellow or gray coloration of face, eyes, and skin, heavy sensation of the body, low or no fever, lassitude, poor appetite, nausea, chest oppression, abdominal distention, hypochondriac pain, loose stools, cold limbs, clear urine, possible edema, possible, palpitations and shortness of breath.

Liver Disease Symptom 2 – Digestion and Appetite

Poor appetite is one of the most common symptoms of liver disease. The poor appetite that occurs in liver disease eventually leads to loss of weight. Improper metabolism of fat, carbohydrates, and proteins may complicate the situation.

Anemia is a more advanced result of improper nutrition from a poor appetite, along with disease in the hepatocytes (liver cells). On top of this, vomiting, nausea, or diarrhea can also occur. Sometimes blood is present in the vomitus, especially if a gastric ulcer is present. The increased rate of ulcers comes from a complex interaction of histamine, nitrogen, bile acids, gastrin, portal hypertension, and an altered mucous membrane lining of the stomach.

Liver Disease Symptom 3 – Light Colored Stool

If the biliary duct is prevented from secreting normal bile pigments into the intestine due to either a lack of bile production or duct blockage, the stool will lack pigmentation and appear lighter in color. Irritable bowels and irregular bowel movements may also be present. If the stools become a light color, it is a clear sign of either liver disease or gall bladder disease. The natural dark color of stools comes almost exclusively from the bile. Light colored stools are a clear sign that either not enough bile is being produced or secreted, or it is not making its way to the intestines due to blockage of the bile duct from stones, scarring, or inflammation. Other descriptions of light colored stools include gray stools and pale stools.

Liver Disease Symptom 4 – Distention and Bloating

A distended abdomen under the right lower ribs may be due to ascites or hepatomegaly. If the distention is severe enough breathing might be labored from pain or the pressure on the diaphragm.

Liver Disease Symptom 5 – Polyuria and Polydypsia

Polyuria/polydypsia (PU/PD) – This is excess thirst and excess urination. This can occur in liver disease, although several other important diseases cause these symptoms as well.

Liver Disease Symptoms – An Alternative View

Other signs and symptoms that suggest Liver disharmony from an oriental medical perspective include:

1. Headaches
2. Skin problems and disorders
3. Allergies
4. Dizziness
5. Tinnitus
6. Tremors, Spasms, Ticks
7. Seizures
8. Strokes
9. Red, itchy eyes
10. Irritability, easy to anger
11. Hypochondriac pain and mid back tension
12. Tight, inflexible tendons and ligaments
13. Depression and mood swings

When diagnosing liver disease, the physician looks at the patient’s symptoms and conducts a physical examination. In addition, the physician may request a liver biopsy, liver function tests, an ultrasound, or a CT scan (computerized tomography scan).

Some common liver disease symptoms include the following, each of which are described briefly below:

• jaundice
• cholestasis
• liver enlargement
• portal hypertension
• ascites
• liver encephalopathy
• liver failure

What is jaundice?

Jaundice is a yellow discoloration of the skin and eye whites due to abnormally high levels of bilirubin (bile pigment) in the bloodstream. Urine is usually dark because of the bilirubin excreted through the kidneys. High levels of bilirubin may be attributed to inflammation or other abnormalities of the liver cells or blockage of the bile ducts. Sometimes jaundice is caused by the breakdown of a large number of red blood cells, which can occur in newborns. Jaundice is usually the first sign, and sometimes the only sign, of liver disease.

What is cholestasis?

Cholestasis is reduced or stopped bile flow. Bile flow may be blocked inside or outside the liver. Symptoms may include:

• jaundice
• dark urine
• pale stool
• bone loss
• easy bleeding
• itching
• small, spider-like blood vessels visible in the skin
• enlarged spleen
• fluid in the abdominal cavity
• chills
• pain from the biliary tract or pancrea
• enlarged gallbladder

Some causes of cholestasis include:

• hepatitis
• alcoholic liver disease
• primary biliary cirrhosis
• drug effects
• hormonal changes during pregnancy
• a stone in the bile duct
• bile duct narrowing
• bile duct cancer
• pancreatic cancer
• inflammation of the pancreas

What is liver enlargement?

Liver enlargement is usually an indicator of liver disease, although there are usually no symptoms associated with a slightly enlarged liver (hepatomegaly). Symptoms of a grossly enlarged liver include abdominal discomfort or “feeling full.”

What is portal hypertension?

Portal hypertension is abnormally high blood pressure in the portal vein, which supplies the liver with blood from the intestine. Portal hypertension may be due to increased blood pressure in the portal blood vessels or resistance to blood flow through the liver. Portal hypertension can lead to the growth of collateral vessels that connect to the general circulation, bypassing the liver. When this occurs, substances that are normally removed by the liver pass into the general circulation. Symptoms of portal hypertension may include:

• a distended abdominal cavity (ascites)
• bleeding of the varicose veins at the lower end of the esophagus and in the stomach lining

What is ascites?

Ascites is fluid build-up in the abdominal cavity, caused by fluid leaks from the surface of the liver and intestine. Ascites due to liver disease usually accompanies other liver disease characteristics such as portal hypertension. Symptoms of ascites may include a distended abdominal cavity, which causes discomfort and shortness of breath. Causes of ascites may include:

• liver cirrhosis (especially cirrhosis caused by alcoholism)
• alcoholic hepatitis
• chronic hepatitis
• obstruction of the hepatic vein

Ascites can also be caused by non-liver disorders.

What is liver encephalopathy?

Liver encephalopathy is the deterioration of brain function due to toxic substances building up in the blood, which are normally removed by the liver. Liver encephalopathy is also called portal-systemic encephalopathy, hepatic encephalopathy, or hepatic coma. Symptoms may include:

• impaired consciousness
• changes in logical thinking, personality, and behavior
• mood changes
• impaired judgement
• drowsiness
• confusion
• sluggish speech and movement
• disorientation
• loss of consciousness
• coma

What is liver failure?

Liver failure is severe deterioration of liver function. Liver failure occurs when a large portion of the liver is damaged due to any type of liver disorder. Symptoms may include:

• jaundice
• tendency to bruise or bleed easily
• ascites
• impaired brain function
• general failing health
• fatigue
• weakness
• nausea
• loss of appetite