Liver is the largest internal organ of our body and has more than 500 functions. Considering the significance of liver, we expect it to cause symptoms even with minimal injury. However, liver is quite resilient with tremendous regenerating capacity and hence, symptoms do not appear till very late. Even with ongoing liver damage, liver tries to cope up by not only enhancing the function of remaining liver but also be growth of the liver tissue.
Based on the acuity of liver damage we can get symptoms. When the liver suffers from acute insult, there are symptoms seen frequently (as we see with routine viral hepatitis). However, if it is chronic or gradual long standing damage, there would be no symptoms. Symptoms only develop in such situation when liver failure begins. We divide symptoms and signs of liver damage in three subgroups
- A) Acute Hepatitis – The symptoms are known to every one of us. The most common cause is viral hepatitis A or E. Patients initially have loss of appetite, fever, malaise, jointpains, muscle aches and then start developing jaundice over a period of 1-2 weeks. The jaundice is apparent with darkening of the color of urine and developing yellow sclera and skin based on severity of liver injury. Jaundice persists for few days to few weeks and then it resolves completely without leaving any scarring to liver. The first sign of recovery is usually the appearance of appetite. Very rarely, although, this hepatitis progresses towards liver failure. In this case, the liver starts to fail and it causes symptoms of involvement of other organs. Patients may have decrease in urine and altered behavior. This is a life threatening condition and patients should be admitted to intensive care unit at the earliest. This is a symptom that may need urgent preparedness for liver transplant
- B) Chronic Hepatitis – It has usually no symptoms. Fatigability and less commonly jaundice (with or without itching)are the most common symptoms noted in patients of chronic hepatitis. These patients are usually identified incidentally by routine evaluation of blood tests and ultrasonography. The most common cause is Hepatitis B and Hepatitis C. The other causes may be many – autoimmune hepatitis, metabolic or vascular liver disease. If these patients are identified based on the reports and are treated for underlying etiology they can have complete resolution of their liver disease. There is no permanent scarring of liver.
- C) Cirrhosis of liver – The name itself means permanent irreversible scarring of liver. Any of the cause of chronic hepatitis can lead to cirrhosis of liver. In early period of cirrhosis (compensated cirrhosis), like chronic hepatitis, there are no symptoms and is identified on reports. But as the disease progress, patients present with any of the following symptoms-
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- Jaundice
- Swelling of feet (Pedal Edema)
- Distension of abdomen (Ascites)
- Blood in vomit (Hemetemesis)
- Black colored stools – Blood in stools (Malena/Hematochezia)
- Altered behavior – Altered sleep (Encephalopathy)
- Decrease in urine volume (Kidney Injury)
- Loss of muscle mass – change in weight (Sarcopenia)
- Loss of appetite
It is highly recommended that patients with liver disease are identified before they develop the symptoms of third subgroup as by that time, liver is irreversibly damaged and the management is directed to only controlling symptoms.
If you have chronic hepatitis or symptoms related to liver disease please contact your liver expert at the earliest.
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