Liver and gallbladder disorders

Alcohol-related liver disease

Jaundice that develops slowly

A history of heavy alcohol consumption

In men, development of feminine characteristics, including loss of muscle tissue, smooth skin, enlarged breasts, shrunken testes, and growth of pubic hair in a female pattern

Sometimes swelling of the abdomen due to accumulation of fluid (ascites)

A doctor's examination

Blood tests

Sometimes liver biopsy

Blockage of a bile duct by a gallstone or, less commonly, by a tumor of the pancreas or bile ducts

Dark urine and light-colored, soft, bulky, oily-looking, and unusually foul-smelling stool

Usually pain in the upper right part or middle of the abdomen

If the cause is a tumor, weight loss and sometimes chronic abdominal pain

Imaging such as

• Ultrasonography (done by putting the ultrasound probe on the abdomen)

• Endoscopic ultrasonography (done with a probe inserted via a flexible viewing tube into the small intestine)

• CT cholangiography (CT of the bile ducts done after a radiopaque contrast agent is injected into a vein)

• MRCP (MRI of the bile and pancreatic ducts using specialized techniques)

• ERCP (x-rays of the bile and pancreatic ducts taken after a radiopaque contrast agent is injected into these ducts through a flexible viewing tube inserted through the mouth and into the small intestine)

Biopsy if imaging results suggest cancer

Cholestasis of pregnancy

Severe itching

Later, jaundice and dark urine

Usually develops during late pregnancy

Blood tests

Usually ultrasonography

Hepatitis (viral)

Symptoms that occur before jaundice develops:

• Nausea or vomiting

• Loss of appetite

• Fatigue

• Constant pain in the upper right part of the abdomen

• Fever

• Sometimes joint pain

Often in people with risk factors, such as recreational use of injected drugs or participation in anal sex

Blood tests for hepatitis viruses

Sometimes liver biopsy if hepatitis is chronic

Primary biliary cholangitis (an autoimmune disorder causing destruction of the small bile ducts in the liver)

Symptoms that often occur before jaundice develops:

• Fatigue

• Itching

• Dry mouth and eyes

Sometimes discomfort in the upper right part of the abdomen, darkening of the skin, and small yellow deposits of fat in the skin (xanthomas) or eyelids (xanthelasmas)

Blood tests to check for the antibodies that occur in most people with this disorder

Ultrasonography and often MRI of the abdomen

Liver biopsy

Primary sclerosing cholangitis (scarring and destruction of small and large bile ducts)

Symptoms that occur before jaundice develops:

• Worsening fatigue

• Itching

Pain in the upper right part of the abdomen

Sometimes light-colored, soft, bulky, oily-looking, and unusually foul-smelling stool

Often in people with inflammatory bowel disease

MRI of the abdomen

ERCP

Other disorders

Breakdown of red blood cells (hemolysis), which may be caused by

• Drugs

• Toxins (including some snake venoms)

• Hereditary red blood cell disorders

• Enzyme deficiencies (such as G6PD deficiency)

• Infections (such as malaria)

Symptoms of anemia (paleness, weakness, and fatigue)

Sometimes use of a drug that causes hemolysis or presence of a red blood cell disorder in a family member

Blood tests

Wilson disease

Tremors, difficulty speaking and swallowing, involuntary movements, loss of coordination, and personality changes

Gold or greenish gold rings in the cornea of the eyes (Kayser-Fleischer rings)

Slit-lamp examination of the eyes to check for Kayser-Fleischer rings

If the diagnosis is still unclear, liver biopsy

Surgical complications such as

• Scarring of the bile ducts due to surgery on or near these ducts

• Reduced blood flow to the liver due to blood loss or other complications of major surgery

Develops soon after surgery, particularly major surgery

A doctor’s examination

Sometimes other tests, depending on the likely causes

Drugs and toxins

(in high doses or as an overdose)

Certain medicinal herbs such as germander, kava, extracts, or pyrrolizidine

Iron when taken in large amounts

Mushroom toxin (from Amanita phalloides)

Use of a substance that can cause jaundice

A doctor's examination