The liver is the body’s built-in detoxifier and without it we cannot function.
This large, football-shaped organ is located in the upper right part of the abdomen, below the rib cage. The liver plays a role in many bodily functions, including removing waste, aiding digestion, filtering the blood, and removing toxins from the body.
“Basically, everything we put into our body — medications, alcohol, supplements, everything — has to go through the liver,” Dr. Lisa Ganjhu, a hepatologist and gastroenterologist at NYU Langone Health, tells TODAY.com.
Nutrients in food are metabolized by the liver into amino acids that the body needs, Ganjhu explains. Liver enzymes break down alcohol and remove toxins from the body.
The liver is the only internal organ that is regenerative, meaning it can repair itself or regrow damaged or lost tissue.
What causes liver disease?
“There is a broad spectrum of liver disease, from early-stage reversible disease to chronic problems to end-stage liver failure,” Dr. Shreya Sengupta, director of the Alcohol-Associated Liver Disease Program at the Cleveland Clinic, tells TODAY.com.
Liver disease can be caused by genetics, autoimmune diseases, metabolic disorders, bile duct blockages, viruses (such as hepatitis), alcohol abuse and obesity, experts note.
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Over time, liver disease can become chronic and lead to fibrosis, or progressive stiffening of the liver due to the buildup of scar tissue as the liver tries to repair itself after damage, according to the Cleveland Clinic. Chronic liver disease can progress to severe, permanent scarring called cirrhosis, Sengupta says. “An even more advanced stage is liver failure or end-stage liver disease,” Sengupta adds.
Liver disease progresses gradually and often slowly, unlike acute liver failure, which can develop suddenly in a person without preexisting liver disease, experts note.
About 1.8% of adults in the United States (4.5 million people) have liver disease, and it causes about 57,000 deaths each year in the United States, according to the Cleveland Clinic.
What are the symptoms of liver problems?
The signs and symptoms of liver disease aren’t always obvious, especially in the early stages. That’s why experts recommend that everyone get routine checkups to screen for liver problems.
Metabolic test results are often the first sign, Ganjhu says. “Abnormal liver enzymes are the most common reason people see a specialist,” Sengupta adds.
Liver diseases can be reversible and even in a chronic or advanced stage, further damage can be prevented, which is why early detection is essential, experts note.
If you experience one or more of these symptoms, with no other known cause, talk to your doctor. Although they are not necessarily a sign of liver disease, it is important to rule out serious causes.
Stellar angiomas
Spider angiomas are a possible sign of liver disease, Sengupta says. These vascular skin lesions look like small red or purple dots with tiny blood vessels that branch out like spider legs, she adds.
They are painless and do not go away. They often appear on the chest, stomach, back, face or arms.
Spider angiomas are common and often harmless. However, if there are multiple ones, they can be a sign of an underlying problem. “Sometimes they are the first sign of a liver problem,” Sengupta says.
Red palm trees
Another possible sign of liver problems on the skin is palmar erythema. “That’s a fancy way of saying your palms are red,” Sengupta says.
Palmar erythema is usually symmetrical, on the heel of both palms, and the rash is whitish, meaning the redness disappears when pressure is applied.
“This could be a sign of hormonal dysfunction due to liver disease,” says Sengupta. It could also be due to other conditions, so talk to your doctor if you have concerns.
Itching without rash
Itchy skin without signs of a rash (also called pruritus) can occur as a result of a buildup of bile salts in the blood due to liver damage, Sengupta says.
“It often gets worse at night for one reason or another, so people are fine all day, and then when they go to bed they can’t stop scratching,” Sengupta adds.
While itching without a rash can be caused by other conditions, it can be a warning sign that deserves attention. “Itching is often a symptom of more advanced liver cirrhosis,” Ganjhu says.
Muscle atrophy
“Muscle loss can be an early, intermediate, or late sign of liver disease; it can happen at any time,” Sengupta says. Muscle loss or atrophy, also called sarcopenia, involves a loss of muscle mass or strength, which can occur with or without fat loss.
People may notice that certain skeletal muscles, such as the triceps or quadriceps, suddenly disappear or become much smaller than before, Sengupta says. In the case of liver disease, this is often linked to malnutrition. Studies have shown that sarcopenia can affect between 20 and 70 percent of patients with cirrhosis.
Abdominal pain
Abdominal pain or discomfort, especially in the upper right side, can be a sign of liver disease. The liver itself doesn’t have pain receptors, Ganjhu says, but liver disease can cause pain in the surrounding tissues of the abdomen.
Some people feel a dull ache or a feeling of strong pressure, she adds. Isolated pain in the right rib is usually not serious, but persistent, unexplained abdominal pain should never be ignored, experts say.
Sleeping troubles
Another symptom Sengupta sees in patients with liver disease is sleep disruption. “An early sign of liver disease is difficulty sleeping, not just falling asleep or staying asleep, but also going to bed later and later,” Sengupta says.
People with chronic liver disease may also wake up frequently during the night, have poorer sleep quality, or disrupted circadian rhythms, Sengupta adds. That said, these issues can also be caused by common sleep disorders or poor sleep hygiene, so it’s important to talk to your doctor.
Pale stools and dark urine
Another possible sign of liver problems you’ll find in your toilet.
Bilirubin is a yellowish byproduct of broken down red blood cells that passes through the liver and is excreted in bile, according to the Cleveland Clinic. Bile exits through the digestive tract and gives stool its color. In a diseased liver that can’t properly process bilirubin, it can build up in the blood and travel to the kidneys, where it’s excreted in urine, giving it a darker color. For this same reason, liver disease can cause lighter stools, Sengupta says.
Nausea and vomiting
Chronic nausea and vomiting are another possible sign of liver disease, experts say. They may be accompanied by loss of appetite and diarrhea, or other gastrointestinal upset.
“This is a tricky case because it could be a lot of other things, and it’s not clear that everyone who has nausea and vomiting has liver disease. The vast majority of people don’t have it,” Sengupta says. “But that’s often what brings people to see a doctor,” she adds.
Persistent fatigue
Unexplained fatigue or malaise (a general feeling of being unwell) are other possible early signs of liver disease, Sengupta notes. Fatigue can be mild or persistent and disabling.
In addition to feeling constantly tired, people may feel weaker than usual. If fatigue is persistent and worrisome, talk to your doctor.
Abdominal swelling
One of the symptoms of liver disease is distension and swelling caused by a buildup of fluid in the abdomen, called ascites, Ganjhu says.
It’s often confused with bloating, an excessive buildup of gas in the digestive tract, but unlike bloating, ascites occurs when there’s a buildup of fluid between the lining of the abdomen and the organs, Ganjhu adds.
Ascites can cause painful swelling of the abdomen, which may require drainage. “In the later stages, women say that all of a sudden they look like they’re nine months pregnant,” says Sengupta.
Yellowing of the skin and whites of the eyes
Jaundice, or yellowing of the skin and whites of the eyes, is a telltale sign that something is wrong with the liver, Ganjhu says.
It occurs when there is a buildup of bilirubin (which has a yellow tint) in the blood. Jaundice usually occurs in cases of more advanced inflammation and scarring or cirrhosis, Sengupta says.
Jaundice can come on suddenly or develop gradually over time. “In the worst case, you’re yellow as a banana, but sometimes it’s just a hint of yellow,” Ganjhu says. Either way, it’s a reason to see a doctor ASAP.
Liver diseases can be treated or cured
In addition to routine checkups, experts encourage people to talk openly with their doctors about their alcohol or drug use. While liver disease can be fatal, it is also treatable and even curable depending on the type and stage.
Early diagnosis and treatment of liver disease can reverse the disease, prevent scarring and cirrhosis, or slow the progression of the lesions, Sengupta said. Treatment may involve medication, weight loss, abstinence from alcohol, and in severe cases, a liver transplant.
“Early treatment can delay the worsening of liver disease by decades,” Sengupta says.