From the Guidelines
Liver damage is often indicated by elevated levels of liver enzymes, particularly alanine transaminase (ALT) and aspartate transaminase (AST), which can be detected through blood tests, as noted in the 2023 study on abnormal liver function tests 1. The severity of liver damage can be classified based on the levels of these enzymes, with mild, moderate, and severe classifications, as outlined in the study 1. Key signs of liver damage include:
- Elevated ALT and AST levels, with ALT being more specific to liver injury
- Elevated alkaline phosphatase (ALP) levels, which may indicate cholestatic liver disease
- Jaundice, or yellowing of the skin and eyes
- Abdominal pain and swelling
- Swelling in the legs and ankles (edema)
- Itchy skin
- Dark urine color
- Pale stool color
- Chronic fatigue
- Nausea or vomiting
- Loss of appetite
- Easy bruising It is essential to seek medical attention if any of these symptoms persist or worsen over time, as early intervention can prevent further liver damage and potentially save lives, as implied by the importance of monitoring liver function tests 1. Regular medical check-ups are crucial, especially for individuals with risk factors such as heavy alcohol use, obesity, or certain medications, to detect liver damage before symptoms appear, as suggested by the study on abnormal liver function tests 1.
From the FDA Drug Label
Hepatitis B virus (HBV) reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV direct acting antivirals, and who were not receiving HBV antiviral therapy. Some cases have resulted in fulminant hepatitis, hepatic failure, and death HBV reactivation is characterized as an abrupt increase in HBV replication manifesting as a rapid increase in serum HBV DNA level. In patients with resolved HBV infection, reappearance of HBsAg can occur. Reactivation of HBV replication may be accompanied by hepatitis, i.e., increases in aminotransferase levels and, in severe cases, increases in bilirubin levels, liver failure, and death can occur.
The signs of liver damage include:
- Fulminant hepatitis
- Hepatic failure
- Death
- Increases in aminotransferase levels
- Increases in bilirubin levels Patients with a history of HBV infection are at risk for HBV reactivation during treatment with ledipasvir and sofosbuvir, which can cause liver damage 2.
From the Research
Signs of Liver Damage
- Jaundice in adults can be an indicator of significant underlying liver disease, caused by elevated serum bilirubin levels in the unconjugated or conjugated form 3
- Conjugated hyperbilirubinemia occurs in disorders of hepatocellular damage, such as viral and alcoholic hepatitis, and cholestatic disorders, such as choledocholithiasis and neoplastic obstruction of the biliary tree 3
- Increases in serum total bilirubin levels, aspartate aminotransferase, and alanine aminotransferase can be indicative of liver damage, particularly in patients with cirrhosis after variceal bleeding 4
- Decomposed cirrhosis, characterized by the presence of jaundice, ascites, variceal haemorrhage, or hepatic encephalopathy, has major implications regarding management and prevention of cirrhosis-related complications 5
Laboratory Evaluation
- Initial laboratory evaluation for liver damage should include fractionated bilirubin, complete blood count, alanine transaminase, aspartate transaminase, alkaline phosphatase, ?-glutamyltransferase, prothrombin time and/or international normalized ratio, albumin, and protein 3
- Imaging with ultrasonography or computed tomography can differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders 3