The liver is a highly resilient organ that can repair damaged cells at a high rate of turnover. However, viruses and diseases can damage the liver faster than it can repair itself. This may happen in a very short period of time, known as acute liver damage, or over an extended period of time, known as chronic liver disease. In either case, the damage may be advanced, resulting in several detectable symptoms.
Yellow Skin and Eyes
One of the most visible signs and symptoms of advanced liver damage is jaundice, the yellowing of the skin and the whites of the eyes. This should not be confused with neonatal jaundice, which is easily treatable and rarely a sign of liver damage. Jaundice is often caused by a condition called cholestasis, the obstruction of bile ducts in the liver, causing bile pigment to spill over into the bloodstream, and eventually into the skin and eyes. Excess bile pigment in the skin and eyes may also be caused by inflammation of the liver, such as viral hepatitis. According to the University of Maryland Medical Center, jaundice is usually the first--and sometimes only--sign of liver disease. The displacement of bile can also cause pale stool and dark urine.
Abdominal Swelling and Itchy Skin
Patients with advanced liver damage may also experience abdominal swelling and itchy skin. Abdominal swelling occurs in liver damage due to an enlarged liver and ascites. According to the University of Maryland Medical Center, ascites is a fluid build-up in the abdominal cavity due to fluid leaks in the liver and intestine. Fluid leaks may be caused by portal hypertension, a resistance of blood flow through the liver, caused by inflammation, scar tissue and duct obstruction. Itchy skin is another symptom of advanced liver disease, usually caused by cholestasis. In the February 2004 issue of "Current Gastroenterology Reports," Dr. Nora Bergasa stated that the mechanisms for liver damage induced itching are likely from bile duct obstruction, causing bile acids and bilirubin to accumulate in the skin, stimulating itch fibers. Dr. Bergasa also proposes that cholestasis may cause an increase in naturally released opioids in the system. Opioids trigger histamine which also causes itching. In the same study, Dr. Bergasa also found that 68 percent of patients with advanced liver disease experienced itching and 74 percent of those patients reported that the itching was severe enough to interrupt sleep.
Brain Function Impairment
Another symptom of advanced liver damage is cognitive impairment caused by a condition called hepatic encephalopathy. According to The Merck Manuals Online Medical Library, hepatic encephalopathy is the deterioration of brain function that occurs because toxic substances normally removed by the liver build up in the blood and reach the brain. Early symptoms include confusion and changes in logical thinking, personality and behavior. Patients may also become sluggish, feel drowsy and experience speech impairment. In later stages of hepatic encephalopathy, patients may lose consciousness and fall into a coma.
References
- University of Maryland Medical Center: Characteristics of Liver Disease
- "Current Gastroenterology Reports"; Pruritus in Chronic Liver Disease: Mechanisms and Treatment; Dr. Nora Bergasa; February 2004
- The Merck Manuals Online Medical LIbrary: Hepatic Encephalopathy
