How to detect a liver problem? Attention, it will be revealed by these symptoms

Liver disease must never be taken lightly. This unique organ has an important metabolic, storage and detoxification function that no other part of the human body can replace when it is damaged.

Sometimes a liver transplant is the only and last chance to save a life.
In Europe, up to 7,000 liver transplants take place every year.
Despite the apparently high number, the number of people waiting is much higher.
This is mainly due to alcohol, but also to infectious liver diseases, which are surprisingly very common.

Don't overlook the symptoms of a diseased liver

Pathological processes in the liver can be different (cancerous, infectious, toxic...), but they have common symptoms. These symptoms tell us that something is wrong with the liver and we need to look for the cause and possible solutions.

In the early stages, the damage may not manifest itself at all. The initial symptoms tend to be non-specific, but encourage us to see a doctor and to look for the cause. As the disease develops, the symptomatology becomes more typical.

The manifestations of a diseased liver are good to know and catch before it is too late!

The liver is an important organ with irreplaceable functions

The liver (Greek: hepar, Latin: jecur, English: liver) is not only one of the largest, but also one of the most important organs of the human body. It weighs a staggering 1500 grams, which represents about 2.5% of the total body weight. If this seems like a lot, it should be noted that in childhood it accounts for up to 5% of a child's total weight.

They are located under the right rib arch, more specifically under the right diaphragmatic arch. They overlap partially to the left. In young children under 3 years of age, they form the bulk of the abdominal cavity and are easily palpable.

Tip: A child is not a miniature of an adult! What are the differences?

What does the liver consist of?

The liver is triangular in shape and consists of four lobes. The right lobe of the liver (lobus dexter) is the dominant lobe and makes up the majority of the liver. The left lobe of the liver (lobus sinister) is slightly smaller. The smallest parts are the caudate lobe (lobus caudatus) and the quadrate lobe (lobus quadratus).

Despite its size, it is a very fragile organ that is protected on the outside by a connective sheath - the sheath.

The parenchymatous tissue itself consists of up to four cell types (hepatocytes - liver cells, Kupffer cells, sinusoidal cells, star cells).

The liver has a very rich vascular supply. It can even be said that it is interwoven with a wide network of blood vessels. It is an extremely vascularised area, which also means that rapid blood loss and even bleeding (accidents) can occur when it ruptures.

The main blood vessels are the portal vein (venae portae), the hepatic vein (venae hepatis) and the hepatic artery (arteria hepatis).

Adjacent to the back of the liver is a small sac-like organ, the gallbladder. The bile ducts lead from the gallbladder and carry bile (bilis in Latin) further into the alimentary canal. Bile is a yellow body fluid that is primarily formed in the liver. The bile dye bilirubin is responsible for its yellow colour.

What are the main functions of the liver?

Because of the liver's involvement in metabolism, we classify it as a digestive tract. In fact, it is an endocrine gland (i.e., with internal secretion) that has multiple functions in the body.

Table with the basic functions of the liver:

Initial symptoms of liver disease are very non-specific

In the early stages of liver disease, there may be no symptoms. The patient may not even be aware that anything is wrong. The initial signs of liver damage are non-specific and therefore may not immediately indicate the severity of the condition or point us in the direction of diagnosis.

They are common to many diseases.

Even liver (hepatic) tests are not elevated. Elevations in liver enzymes, which are obtained by blood tests, occur only in the later stages of the disease.

Abdominal pain below the right rib cage

Abdominal pain tends to be localised under the right rib arch, often mimicking gallbladder disease or irritation of the stomach and gallbladder by dietary error. In some cases it may be diffuse, i.e. without precise localisation.

Nonspecific abdominal pain is replaced by precisely localized pain in the liver region. These are accompanied by their enlargement, a general increase in abdominal volume, and an enlarged venous pattern on the anterior abdominal wall.

The pressure of the bulky abdomen in the later stages presses on the diaphragm and lungs, making breathing difficult.

Bloating, constipation and other digestive problems

In liver disease, bloating or excessive flatulence - flatulence - often occurs. This causes abdominal cramps, uncomfortable pressure or a feeling of vomiting. The abdomen is visibly distended and larger. It is harder to the touch, more sensitive or painful.

There are defecation disturbances. Mostly constipation - a problem with defecation. Occasionally diarrhoea may occur. Stools are normal in colour, but in later stages they are distinctly pale - cholic.

Sometimes there is an admixture of fresh blood in the stool. In alcoholics with stomach ulcers or other bleeding conditions, it tends to be tarry black.

Bruises and contusions without cause?

Bleeding manifestations on the skin and mucous membranes or from organs and sinuses are also a sign of a diseased liver. Liver diseases are associated with changes in haemostasis. This means that blood diseases may not primarily damage the liver, but the opposite may also be true.

A diseased liver also results in changes in the fibrinolytic system. Blood tests reveal an increase in prothrombin and activated thromboplastin time. Translated, this means that there is an increased risk of bleeding. Often, thrombocytopenia is also present.

Blood bruising and contusions are therefore more likely to be observed on the patient's body. There is also an increased risk of bleeding during trauma, surgery or routine medical procedures such as tooth extraction.

Tip: Petechiae as a manifestation of minor to fatal diseases

Other manifestations that may be related to liver damage:

1. General fatigue, malaise, malaise
2. headaches, migraines
3. epileptic seizures
4. joint and spinal pain
5. muscle pain
6. increased body temperature
7. increased tooth decay
8. inflammation of veins
9. haemorrhoids
10. brain atrophy, thought disorders
11. depression, aggressiveness, other behavioural disorders
12. concentration disorders
13. memory disorders, amnesia
14. hand tremors
15. metabolic abnormalities, hypoglycaemia

This is how liver damage manifests itself in more advanced stages

Yellow discolouration of the skin, mucous membranes and whites of the eyes

Yellow discolouration of the skin, mucous membranes and whites of the eyes is technically called icterus (jaundice). If the yellow discolouration appears only on the whites of the eyes or the mucous membranes of the mouth, for example, this condition is called subicterus.

Yellow discoloration of the skin, mucous membranes and eyes occurs because of an increased concentration of bilirubin in the serum and tissues. Bilirubin is a so-called bile dye that is produced as a waste product of the metabolism of red blood dye (heme), which occurs in the liver.

From the liver, it enters the bile duct and is subsequently excreted from the body in the urine and faeces (it is also responsible for their colouring).

When the liver is damaged, bilirubin diffuses into the tissues, causing them to turn yellow. Conversely, the excretion of the yellow dye into the bile duct and intestine is impaired, causing the faeces to be poorly coloured. The stool is distinctly pale - cholic.

Unsightly skin manifestations on the face and elsewhere on the body

Liver spots, sometimes called age spots, are flat patches of brownish to grey colour. They do not rise above the level of the skin. They range in size from a few millimetres to centimetres. They occur mainly on the face but also on the hands or feet.

They are usually observed in elderly patients with chronic liver disease or toxic liver damage due to long-term use of large amounts of medication. Due to the higher use of alcohol and drugs in younger individuals, they are also more common in this age group (cirrhosis of the liver, hepatitis).

In addition to liver spots, spider nevi occur on the skin in liver disease. Spider nevi are a cutaneous manifestation of cirrhosis or liver failure and are therefore mostly seen in alcoholics or people with other terminal liver damage.

They usually appear on the face and resemble a ruptured blood vessel. They are small, red, several millimetres in size due to dilated capillaries. Externally, they look like a red dot with tiny red hairs protruding from the sides.

The appearance resembles that of a spider, hence the name. The enlargement of the veins on the nose is frequent and visually enlarges the nose, which is coloured pinkish-purple.

Large abdomen and thin legs resembling the body of a spider

People with more severe or advanced liver disease resemble a spider in appearance. This is due to the thin legs and, in turn, a huge abdomen filled with water - ascites. It is most often observed in liver cirrhosis, which is caused by toxic liver damage.

Liver cirrhosis is in most cases caused by the toxic effect of alcohol.

Ascites arises subtly and gradually. Its onset is preceded by a feeling of abdominal fullness and pressure and other non-specific symptoms such as flatulence, bloating, constipation, weight gain and gradual increase in abdominal volume. Malnutrition and muscle wasting are responsible for the thin limbs.

Several factors are involved in its occurrence, namely, an increase in portal pressure (v. portae - the portal vein of the liver), a decrease in plasma pressure, retention of water and electrolytes, and impaired lymphatic drainage with its excretion directly into the abdominal cavity.

This ultimately causes the appearance of free fluid in the abdominal cavity outside the digestive tube.

The enlargement of the liver and spleen at the same time is sometimes palpable

Liver enlargement (hepatomegaly) occurs in liver disease, but also in other diseases (parasitic diseases, heart disease, infectious diseases, most often blood diseases).

In most cases it is associated with enlargement of the spleen (splenomegaly).

In the case of a combination of liver and spleen enlargement, we speak of hepatosplenomegaly or hepatosplenomegalic syndrome.

This symptom or syndrome is not in itself dangerous for a person. But it does indicate that something is wrong and the cause of the manifestation should be sought. It may be life-threatening.

Enlargement of the liver and spleen is usually detected either by sonographic examination, but sometimes also by palpation or by the naked eye.

The abdomen is like the head of a jellyfish

One of the most obvious signs of liver damage is a distinctive venous pattern on the front of the abdomen, resembling the head of a jellyfish (lat. caput medusae).

The veins are prominent because of their enlargement, due to increased pressure of the hepatic veins (mainly in the v. portae). They are not only visible but also palpable and wavy.

Interesting:
The name for the enlargement of the superficial abdominal vessels, caput medusae (head of the medusa), is based on the similarity of the vein pattern to the head of the Greek mythological figure Medusa.
Medusa was the daughter of the god Phokyn and his wife Keto, and the only beautiful and mortal of the trio of sister gorgon-medusae.
Her beauty was so extraordinary that even Poseidon himself succumbed to her in the temple of Athena.
However, this angered the goddess Athena so much that she turned the beautiful Medusa into a monster with snakes for hair and a gaze that killed.

Esophageal bleeding ends in death.

In liver disorders, the hepatic circulation is also altered. There is increased pressure in the liver vessels, called portal hypertension. This not only results in the formation of free fluid in the abdominal cavity and a visible venous pattern on the front of the abdomen. It also increases the pressure in the esophageal vessels.

The esophageal blood vessels dilate and bulge under the increased pressure. We call them esophageal varices. The damaged blood vessel wall can rupture, causing severe and uncontrollable bleeding.

Because of the location of the bleeding, it is almost impossible to stop, and many patients die from bleeding outside of a medical facility.

Esophageal varices occur mainly in liver cirrhosis in chronic alcoholics, similar to ascites and caput medusae. They are also often diagnosed in patients with liver cancer.

Hepatic coma is a step preceding death.

Hepatic or hepatic coma is a sign of severe liver damage leading to loss of consciousness. It is a serious condition that ends in death. It is the second most common cause of death in patients with liver disease, after bleeding from esophageal varices, and the last stage of liver failure.

Hepatic coma results from the accumulation of ammonia and other poisonous substances in the blood because the diseased liver is unable to dispose of them.

The condition is preceded by manifestations of hepatic encephalopathy (brain damage). Patients are sleepy during the day, but suffer from insomnia at night. Alcoholic hand tremors are typical. This is noticeable externally, also in written text - the writing is shaky.

They have problems with thinking and memory. One could say that they are very low in intelligence, which is due to brain atrophy.

Heart rhythm disturbances, low blood pressure, respiratory disturbances, apnoeic pauses follow. Cardiac and respiratory failure results in terminal loss of consciousness and death.