Merck Manual

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Overview of Liver Disease

By

Danielle Tholey

, MD, Thomas Jefferson University Hospital

Last full review/revision Jan 2020| Content last modified Jan 2020
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Liver disease can manifest in many different ways. Characteristic manifestations include

  • Jaundice (a yellowish discoloration of the skin and whites of the eyes)

  • Cholestasis (reduction or stoppage of bile flow)

  • Hepatomegaly (liver enlargement)

  • Portal hypertension (abnormally high blood pressure in the veins that bring blood from the intestine to the liver)

  • Ascites (accumulation of fluid in the abdominal cavity)

  • Hepatic encephalopathy (deterioration of brain function due to buildup of toxic substances normally removed by the liver)

Sometimes the manifestations of liver disease are not obvious. For example, symptoms may include fatigue, a general feeling of illness, loss of appetite, and mild weight loss. However, people may not notice these symptoms, and these symptoms are also typical of many other diseases. Thus, liver disease can easily be overlooked, particularly in its early stages.

Table
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Some Features* of Liver Disease

Feature

Description

A yellowing of the skin and whites of the eyes

Reduction or stoppage of bile flow

Hepatomegaly

Liver enlargement

Accumulation of fluid within the abdomen, sometimes causing the abdomen to swell

Confusion caused by deterioration of brain function due to buildup of toxic substances in the blood, which are normally removed by the liver

Bleeding in the esophagus and/or stomach, often from enlarged, twisted veins (varicose veins, or varices)

Abnormally high blood pressure in the veins that bring blood from the intestine to the liver (the portal vein and its branches)

Skin symptoms

Spiderlike blood vessels on the face and chest

Red palms

Bright red complexion

Itching

Blood abnormalities

A decreased number of red blood cells (anemia)

A decreased number of white blood cells (leukopenia)

A decreased number of platelets (thrombocytopenia)

A tendency to bleed (coagulopathy)

Hormonal abnormalities

High levels of insulin but a poor response to it ( insulin resistance), leading to high blood sugar levels

Malfunction of the adrenal glands, leading to light-headedness when a person stands up, fatigue, and sometimes patches of dark skin

In women, ending of menstrual periods and decreased fertility

In men, erectile dysfunction and development of feminine characteristics (feminization), such as loss of muscle tissue, enlarged breasts, and shrunken testes

Heart and blood vessel abnormalities

An increase in heart rate and in the amount of blood pumped

Low blood pressure (hypotension)

General symptoms

Fatigue

Weakness

Weight loss

Poor appetite

Nausea

Fever

Abdominal pain

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

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