Disease can be acute (lasting less than six months) or chronic (lasting more than six months). Those with liver disease may appear quite healthy or go to the other extreme, suffering from ascites (an abnormal accumulation of fluids in the abdomen); encephalopathy (mental confusion); and/or jaundice, fatigue, stomach discomfort, etc. Some symptoms of possible liver disease include the following: fatigue (the classic sign), abdominal pain, fever, flu-like symptoms, jaundice (another classic sign), altered mental status, severe itching for no apparent reason, abdominal distention, weight gain, altered sleep habits, joint aches, a persistent rash, and/or depression. Evidence of liver damage also includes muscle wasting, particularly of the upper body. As the liver struggles to manufacture proteins and is not able to keep up with the demand, muscle mass will begin to deteriorate. In addition, the spleen may enlarge to compensate for the decreased function of the liver (splenomegaly). The spleen plays a role in the storage of platelets (blood cells that have a clotting factor). Therefore, an enlarged spleen indicates a low platelet count (thrombocytopenia).
Other abnormalities may appear as the liver begins to fail to metabolize endocrine hormones properly: liver palms (palmar erythema), a condition where the palms turn a bright red color, which may be associated with some throbbing or warmth of the hands; enlarged blood vessels on the upper chest, back, face and arms that resemble little red spiders (spider angiomatas), which will turn white if a little pressure is applied to the centers; body hair patterns may change with men shaving less often and women having less underarm hair; breasts in women may become tender and enlarge in men.
Other conditions, particularly indicating cirrhosis, include the following: Terry’s nails (a condition where the normal pinkish color of the nails turns white and the half-moons disappear); paper money skin (a condition in which the upper body is covered with numerous thin blood vessels that resemble the silk threads of a dollar bill). Conditions that suggest a specific liver disease include the following: Xanthomas (an irregular yellow nodule or patch usually found on the ankles, elbows, and knees); Xanthelasmas (a yellow nodule or patch on the eyelids) associated with very high cholesterol levels and found in those with primary biliary cirrhosis. These irregular patches can be very disfiguring and painful and can also be found in other liver diseases, as well as in other diseases associated with elevated cholesterol levels.
Those with liver disease as a result of alcohol abuse often display the following conditions: Dupuytren’s contracture (a puckering of the palm that prevents a person from totally straightening out his hand). Severity is directly correlated with the quantitiy of alcohol consumed; Parotid gland enlargement, causing the earlobes to protrude at right angles to the jaw; Testicular atrophy (a shrinking of the testicles), which can also be a manifestation of hemochromatosis (an iron metabolism problem, resulting in accumulation); Hepatic bruit (a harsh, musical sound heard through a stethoscope when placed over the liver) being suggestive of liver cancer.
Several different viruses specifically attack the liver, causing viral hepatitis. Each is different with distinct characteristics. Other viruses can also attack liver cells, including the herpes simplex virus and the Epstein-Barr virus. But since the liver is not the principal organ damaged by these viruses, they are not considered to be hepatitis viruses. Acute hepatitis means that the duration of the disease lasts less than six months, with a complete recovery in that time. Chronic hepatits will last longer than six months, increasing the risk of developing cirrhosis of the liver and other complications. Fulminant hepatitis is an especially serious form associated with jaundice, coagulopathy (blood clotting disorder), and encephalopathy (degenerative brain disease). Liver failure occurs abruptly, usually within eight weeks of onset of symptoms or about two weeks after the onset of jaundice.
Regardless of the cause, cirrhosis is the irreversible end product of any number of different liver diseases. A healthy liver has the potential to repair and regenerate itself, but when cirrhosis has occurred, it no longer has that capacity. The process can be slowed or even halted, but cannot be reversed to where that area becomes healthy again. There are two basic types of cirrhosis: Macronodular cirrhosis, in which the damaged liver nodules become very large, and Micronodular cirrhosis, where the nodules become very small. Either way, the result is the same.
Cirrhosis interferes with everyday function that can lead to other more serious complications. Bleeding problems can result since the liver is not able to keep up with all its demands. A simple act of brushing the teeth or shaving can cause bleeding of varying lengths and intensities. Bleeding always allows other pathogens entry into the bloodstream.
Since the kidneys and the liver work closely together, kidney function is affected, causing its filtering system to slow. This can lead to fluid retention (edema and ascites) and on to eventual dialysis. Those with cirrhosis are also at risk for osteoporosis since the liver can no longer assimilate calcium or Vitamin D as it once did. This is accentuated if being treated for pruritus (intense itching) with a drug called Questran (cholestyramine), which inhibits fat-soluble vitamin absorption. Those who have cirrhosis are at a higher risk for developing liver cancer, as well as other kinds of cancers, including lung, larynx, pancreas, kidney, urinary bladder, pharynx, colon, and breast.