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Signs and Symptoms of Liver Disease

Signs and Symptoms of Liver Disease. Symptoms. Fatigue. Nausea. Occurs with more severe disease May be provoked by odours of food or fatty foods Poor appetite with weight loss – acute disease or advanced cirrhosis Diarrhoea only in severe jaundice - lack of bile acids in intestine.

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Signs and Symptoms of Liver Disease

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  1. Signs and Symptoms of Liver Disease

  2. Symptoms Fatigue Nausea Occurs with more severe disease May be provoked by odours of food or fatty foods Poor appetite with weight loss – acute disease or advanced cirrhosis Diarrhoea only in severe jaundice - lack of bile acids in intestine • Most common and characteristic symptom of liver disease • Usually occurs on exercise or activity • “Liver pain” • Due to stretching or irritation of capsule • Severe pain in liver abscess or severe veno occlusive disease – occasionally in acute hepatitis Upper Right Quadrant Ache

  3. Symptoms Itching/Pruritis Jaundice Usual progression: Darkened urine Scleralicterus Jaundice in skin Pale stools + steatorhea Undetectable til 2.5mg/dL If no dark urine: Indirect (unconjugated) hyperbilirubinaemia Eg in haemolytic anaemia or genetic condns of bilirubin conjugation • In acute liver disease: • Early in obstructive jaundice • Later in hepatocellular disease (acute hepatitis) • In chronic liver disease: • Usually presenting symptom in cholestatic disease (before jaundice)

  4. Signs • Hepatomegaly • Congestion, inflammation, steatosis • Haemochromatosis, amyloidosis and many more • Hepato-shrinkaly aka cirrhotic liver • Fibrosis of the liver

  5. Oestrogen related signs • Palmer erythema • Gynaecomastia • Spider naevi • Testicular atrophy and body hair loss

  6. Signs in the hands • LeuconychiaTotalis – due to hypoalbuminaemia • Koilonychia – secondary to iron deficiency anaemia • Dupuytren’s Contracture – cause unknown • Clubbing

  7. Signs of portal Hypertension • Ascites – Sequestration of fluid in abdomen due to increased pressure • Worsened by increased fluid retention in kidneys due to increased aldosterone and renin • Caput medusa – distended, engorged paraumbilical veins – radiating from umbilicus (flow towards legs) • Oesophageal varices – collateral portal blood flow through vessels in stomach and oesophagus • Splenomegaly – congestion of red pulp

  8. Malnutrition issues in liver disease • Wasting – once cirrhotic, pt becomes more catabolic, depriving them of essential nutrients eg protein, causing muscle breakdown. • Weight loss also occurs due to increased catabolic state, causing lipolysis • Multiple factors contribute to malnutrition • Poor dietary intake • Alterations in nutrition absorption • Alteration in protein metabolism • One of most important factors influencing mortality and morbidity in end stage liver disease

  9. Signs of Hepatic encephalopathy • Damage to neurons due to livers inability to metabolise ammonia to urea • Brain oedema with swelling of grey matter • May result in cerebral herniation • Progression of S&S: • Forgetfulness, irritability, mild confusion • Inverted sleep/wake cycle, trouble, issue with coordination, marked irritability • Altered consciousness, asterexis(disappears as somnolence worsens), disorientation, amnesia, hyperreflexia • Seizures, coma, death

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