Symptoms of Liver Disease
The symptoms of liver disease vary widely, ranging from asymptomatic presentation to severe manifestations including jaundice, abdominal pain, fatigue, and complications of advanced disease. 1
Common Symptoms and Clinical Presentations
General Symptoms
- Fatigue is the predominant complaint in approximately 85% of patients with liver disease 2
- General ill health and malaise are common symptoms 1, 2
- Right upper quadrant pain or epigastric pain 1, 2
- Anorexia and weight loss 1, 2
- Nausea and vomiting 1
- Jaundice (yellowing of skin and eyes) 1, 2
Specific Physical Findings
- Hepatomegaly (enlarged liver), which may be painful in some cases 1, 2
- Splenomegaly (enlarged spleen) 1
- In advanced disease: spider nevi, palmar erythema, and caput medusa 1, 2
- Ascites (fluid accumulation in abdomen) in advanced disease 1, 3
Disease-Specific Presentations
Acute Liver Disease
- Abrupt onset with prodromal symptoms followed by dark urine and jaundice 4
- Elevated liver enzymes (AST, ALT) that rise rapidly during prodromal period 4, 5
- Approximately 25% of autoimmune hepatitis cases present with acute symptoms that can mimic viral or toxic hepatitis 1, 2
- Acute liver failure may present with jaundice, coagulopathy (INR ≥2), and hepatic encephalopathy 2, 6
Chronic Liver Disease
- Many patients are asymptomatic in early stages 1, 2
- Approximately 25-37% of autoimmune hepatitis patients are asymptomatic at diagnosis 2
- Approximately 25-33% of patients have already developed cirrhosis by the time of diagnosis regardless of symptoms 2
- Symptoms may develop gradually over years 3
Polycystic Liver Disease
- Abdominal fullness 1
- Lack of appetite or early satiety 1
- Acid reflux 1
- Pain in rib cage, sides, abdomen or back 1
- Shortness of breath 1
- Limited mobility 1
- Involuntary weight loss 1
Complications of Advanced Liver Disease
Portal Hypertension Complications
- Esophageal varices (which may bleed) 1, 3
- Ascites (fluid accumulation in the abdomen) 1, 3
- Hepatic encephalopathy (confusion, altered level of consciousness) 1, 3
Other Complications
- Jaundice (yellowing of skin and eyes) 1, 4
- Hepatic venous outflow obstruction 1
- Recurrent cyst infection (in polycystic liver disease) 1
- Recurrent cyst hemorrhage (in polycystic liver disease) 1
- Coagulopathy (bleeding disorders) 1, 3
- Renal dysfunction 1
Special Considerations
Asymptomatic Presentation
- Many patients with early liver disease have no symptoms 1, 2
- Abnormal liver function tests may be the only indication of disease 6, 5
- Regular screening is important for high-risk individuals 1
Age and Gender Considerations
- Patients aged ≥60 years with autoimmune liver disease have more autoimmune thyroid and rheumatic diseases than adults ≤30 years 2
- Young adults more often have inflammatory bowel disease and autoimmune hemolytic anemia with liver disease 2
- Women account for >80% of liver transplants for polycystic liver disease 1
Laboratory Abnormalities
- Elevated liver enzymes: AST, ALT, ALP, GGT 6, 5
- Elevated bilirubin (causing jaundice) 4, 5
- Decreased albumin and prolonged prothrombin time in advanced disease 3
- Elevated IgG levels in autoimmune hepatitis 2
Diagnostic Pitfalls
- Approximately 25-37% of patients with liver disease may be asymptomatic at diagnosis, leading to delayed recognition 2
- In acute severe autoimmune hepatitis, 29-39% may have negative or weakly positive autoantibodies 2
- Normal serum IgG levels are found in 25-39% of acute severe autoimmune hepatitis cases 2
- Symptoms may be nonspecific and overlap with other conditions 1, 6