Signs and symptoms of liver damage

Your liver is able to mask early stages of damage, and any signs or symptoms can be vague and easily confused with other problems. Unfortunately, there are often no signs of liver disease until the damage is considerable and your liver is struggling to cope.

Early symptoms of liver damage include:

Fatigue and weakness

A general feeling of poor health

Loss of appetite

Nausea and vomiting

Loss of weight

Pain or discomfort in the abdomen (the area below the ribs, including the stomach area)

Feeling itchy

Small red veins that resemble the body of a spider (known as spider naevi)

Enlarged and tender liver (you may feel very tender below your right ribs)

Dark urine/grey pale stools (faeces)

Loss of sex drive (libido)

Symptoms that indicate more severe damage and that require medical advice to be sought at once include:

Skin and eyes turning yellow (jaundice)

Swelling of the abdomen

Fever with high temperatures and shivers

Vomiting blood

Dark black tarry stools (faeces)

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Diagnosing liver problems

There are a number of tests that doctors can do to try and find out if something is wrong with your liver and what the problem is. Some of the more common tests are:

Liver function tests

By taking a sample of your blood and studying what it contains and what it’s lacking, doctors can tell a lot about how your liver is functioning.

Liver function tests (LFTs) measure levels of enzymes found in your liver (proteins needed to carry out the liver’s functions). These will help to indicate if your liver is inflamed or if damage is present. When your liver is damaged, some of these enzymes leak into your bloodstream and levels will be much higher than normal.

Your liver produces chemicals that help your blood to clot, so the speed at which your blood is clotting may also be measured.

If your liver isn’t working properly, waste products such as bilirubin may build up in your blood.

LFTs aren’t completely specific to the liver and can be affected by disorders and diseases that don’t affect your liver directly.

Abnormal liver function test results aren’t uncommon. However, they should always be followed up with further investigation or repeat tests.

Autoantibody tests

Antibodies are proteins made by the immune system to fight infection. However, occasionally the immune system can start to attack the cells or tissues of the body, which is called autoimmunity. Certain antibodies target cells in the liver and the presence of these antibodies in blood tests may be used to diagnose autoimmune liver diseases.

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Virology

Diagnoses of hepatitis virus infections are usually made by detecting proteins produced by the virus, or antibodies made to fight the virus in blood samples.

Often an initial test will be followed up with a confirmatory blood test to:

See if the virus is still present (active)

Check the amount of virus in your blood, known as your viral load

Doctors will monitor your viral load during treatment to look for a response to antiviral medication.

Ultrasound scan

Ultrasound – the same technology used in pregnancy – is often used to look at your liver. Ultrasounds are painless – gel is smeared on the skin over the liver and then the ultrasound equipment scans the area. Sound waves travel into the body and the echoes are picked up and used to build a black and white picture of the condition of the liver.

They’re often used to check the condition of the bile ducts and gall bladder. Scarring such as fibrosis is difficult to see, but fatty deposits show up as bright white areas. It may also be possible to see if your liver is enlarged or misshapen.

CT and MRI scans

These imaging tests may be used to gain a more detailed picture of your liver.

CT (computed tomography) uses X-ray equipment to show cross sections or ‘slices’ of your tissue and organs. Sometimes, CT scans are used by doctors to help guide entrance sites for biopsies (see below).

MRI (magnetic resonance imaging) uses a tube scanner that creates powerful magnetic fields to provide a more detailed view of your organs and tissues than a CT scan. MRI is a useful tool for investigating tumours both before and after treatment.

Liver biopsy

There are many causes of liver disease and it’s sometimes difficult to diagnose a condition based on symptoms and simple blood tests such as LFTs. A liver biopsy may be needed to diagnose the cause of your liver disease and identify how advanced it has become.

A liver biopsy is a process where a tiny piece of the liver is taken for study. A fine hollow needle is passed through the skin into the liver and a small sample is withdrawn with the needle.

The test is usually done under local anaesthetic. As it can be uncomfortable and there’s a small risk of internal bleeding or bile leakage, a stay in hospital of at least six to eight hours is required. You may be allowed home later the same day or may need to remain in hospital overnight.

The tissue sample is examined under a microscope to look for information on the stage and cause of your liver damage.

An appointment will then be arranged to discuss your results with your specialist who will explain the findings and any treatment required..

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