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Risk Factors
Screening
Diagnosis
Many people withliver diseaseare entirely unaware of their condition, in part because the signs of liver problems are often subtle or nonexistent. In 2023, a review of the National Health and Nutrition Examination Survey (NHANES) found that 93% of people withfatty liver diseasehad no knowledge of their condition and that 8.8% were found to have advanced liver disease.
In most cases, the symptoms of liver disease are only apparent when there is significant and often irreversible liver damage. This is why it is important to know the early signs of liver disease andhepatitis(liver inflammation). This is especially true if you haverisk factors for liver disease.
This article takes a closer look at the signs of liver disease, including the symptoms you are likely to experience at different stages of the disease. It also explains how liver disease is diagnosed and when you might consider screening in the absence of symptoms.
Could You Have Liver Disease Symptoms?
Liver disease, also known as hepatic disease, is a general term that refers to any condition affecting the liver. There areacuteforms of liver disease that develop abruptly and generally resolve with treatment andchronicforms that persist, causing progressive damage to the liver.
Chronic liver disease can progressasymptomatically(without symptoms) over years and only become apparent when irreversible damage is done.
Symptoms like fatigue, dark urine, and jaundice (yellowing of the skin and eyes) can develop with the onset of cirrhosis (extensive liver scarring) and get progressively worse as liver disease advances to end-stage liver disease and liver failure.
The three most common forms of chronic liver disease in the United States are:
What makes these diseases so concerning is that only a handful of people are aware of their condition. According to the American Liver Foundation, no less than 100 million people in the United States currently have some form of liver disease, of whom only 1.8% are diagnosed.
Because the symptoms are often subtle or easily missed or attributed to other causes, it is important to understand not only the signs of liver disease but also the factors that place you at an increased risk.
In the United States, this includes:
Where Is My Liver Located?Theliveris the largest internal organ in the human body, roughly the size of a football. It is situated on the right side of the upper abdomen just below the ribcage anddiaphragm(the fibrous muscle separating the abdominal and chest cavities).The liver itself has no pain receptors. Any pain or discomfort felt is due to inflammation or injury of the membrane surrounding the liver, called the liver capsule.
Where Is My Liver Located?
Theliveris the largest internal organ in the human body, roughly the size of a football. It is situated on the right side of the upper abdomen just below the ribcage anddiaphragm(the fibrous muscle separating the abdominal and chest cavities).The liver itself has no pain receptors. Any pain or discomfort felt is due to inflammation or injury of the membrane surrounding the liver, called the liver capsule.
Theliveris the largest internal organ in the human body, roughly the size of a football. It is situated on the right side of the upper abdomen just below the ribcage anddiaphragm(the fibrous muscle separating the abdominal and chest cavities).
The liver itself has no pain receptors. Any pain or discomfort felt is due to inflammation or injury of the membrane surrounding the liver, called the liver capsule.
How Liver Disease Symptoms Progress in Stages
Chronic liver diseases tend to progress silently over many years before noticeable symptoms develop.
With hepatitis B and C, it can take 10 to 20 years for an acute infection to progress to cirrhosis.ALD generally takes at least 20 years of heavy drinking before signs ofalcoholic hepatitisappear,while MASLD can take anywhere from three to 20 years before a severe form of the disease calledmetabolic dysfunction-associated steatohepatitis (MASH)develops.
Although the timelines can vary, the stages of the disease and the sequence of symptoms remain largely the same. With chronic liver disease, the stages can be broadly categorized asfibrosis, cirrhosis, and liver failure.
Fibrosis
While the underlying causes of chronic liver diseases differ, the one condition they all share ischronic inflammation. When the liver is involved, the inflammation is referred to ashepatitis.
Althoughinflammationis the body’s way of controlling disease, it can cause significant damage if it persists unchecked.With hepatitis, the persistent, low-level inflammation can progressively damage liver cells and cause the formation of scar tissues known asfibrosis.
Fibrosis itself causes no symptoms, and it can be difficult to diagnose as imaging tests often fail to detect any changes until the scarring is extensive. The only indication at this stage may be abnormalities in blood tests used to evaluate liver function.
Cirrhosis
As scar tissues increasingly supplant healthy tissues, the liver will start to lose its ability to perform key functions, including the production ofbilefor digestion, the storage ofglucosefor energy, the synthesis ofcoagulantsfor blood clotting, and the filtering of waste from the bloodstream.
When fibrosis is severe enough to cause the loss of liver function, you are said to havecirrhosis. This is the stage when symptoms start to develop.
When the liver is no longer functional—a condition referred to asdecompensated cirrhosis—more overt symptoms will develop, including:
Does Liver Disease Always End With Cirrhosis?Not everyone with chronic liver disease will progress to advanced disease. In fact, only 20% to 30% of people with viral hepatitis progress to cirrhosis.Similarly, only 20% to 25% of people with ALDand 20% to 30% of people with MASLDexperience severe progression leading to cirrhosis and liver failure.
Does Liver Disease Always End With Cirrhosis?
Not everyone with chronic liver disease will progress to advanced disease. In fact, only 20% to 30% of people with viral hepatitis progress to cirrhosis.Similarly, only 20% to 25% of people with ALDand 20% to 30% of people with MASLDexperience severe progression leading to cirrhosis and liver failure.
Complications of Cirrhosis You May Not Know
Liver Failure
In rare cases, decompensated cirrhosis is partially reversible. In most instances, however, decompensation is the gateway to liver failure—the end stage of liver disease. This is the point at which the loss of liver function has become life-threatening.
With liver failure, severe complications will develop. While efforts can be made to sustain life, aliver transplantis ultimately the only means of survival.
In addition to symptoms of severe hepatitis, liver failure can also manifest with:
Does Cirrhosis Cause Cancer?Cirrhosis can also increase the risk ofhepatocellular carcinoma (HCC), the most common form of liver cancer. Studies suggest that 80% to 90% of people with HCC have cirrhosis and that roughly 12% of people with cirrhosis will eventually develop HCC, usually within the span of 10 years.
Does Cirrhosis Cause Cancer?
Cirrhosis can also increase the risk ofhepatocellular carcinoma (HCC), the most common form of liver cancer. Studies suggest that 80% to 90% of people with HCC have cirrhosis and that roughly 12% of people with cirrhosis will eventually develop HCC, usually within the span of 10 years.
Signs of Liver Disease in Someone Else
Signs of liver disease are as difficult to spot in someone else as in yourself. But this doesn’t mean you shouldn’t look, particularly if someone you love is older and has multiple health concerns.
The simple fact is that the risk of cirrhosis increases with age and that most diagnoses are made when the disease is advanced and damage to the liver is severe.
A 2019 study inJAMA Network Opensuggests that the current median age of diagnosis for cirrhosis in the United States is 58 years.This is the stage of life—between ages 55 and 64—in which nearly half of all cirrhosis deaths occur.
Because older adults often juggle multiple chronic conditions, they may ignore or miss the early signs of liver disease when dealing with more overt illnesses like diabetes, heart disease, or chronic obstructive pulmonary disease (COPD).
This is why it is important to intervene if a loved one has signs of liver disease—or simply has risk factors for the disease with no overt signs or symptoms.
In the past, the American Association for the Study of Liver Diseases (AASLD) advised against routine screening for fatty liver disease due to uncertainties surrounding diagnostic tests and their long-term benefits. But in 2022, the group reversed its decision and now endorses screening of people suspected of having fatty liver disease.
Similarly, the American Gastroenterology Association (AGA) and the American Diabetes Association (ADA) now recommend the routine screening of people at risk of liver disease, including those with:
A Complete Guide to a Low-Protein Diet
Steps to Getting Liver Disease Symptoms Treated
For example, with chronic viral hepatitis,alanine aminotransferase (ALT)levels remain elevated whileaspartate aminotransferase (AST)levels are often normal.With alcoholic liver disease, the opposite may be true,while MASLD usually causes high levels of both AST and ALT.
Based on these early clues, your healthcare provider may order one of several imaging tests to check for abnormalities in your liver, including nodules, lesions, or tumors. Options include:
In addition, your healthcare provider may order a blood test called a hepatitis virus panel that can detect current or past infection with hepatitis A, B, or C.
Another routine blood test called acomplete blood count (CBC)may be especially useful in people with ALD, who commonly experiencethrombocytopenia(low platelet count) andanemia(low red blood cell count).
If needed, aliver biopsymay be performed to obtain a small sample of liver tissue (usually with a hollow-core needle inserted through a small incision in your belly). A liver biopsy can definitively diagnose cirrhosis and how advanced the condition is.
If liver disease is diagnosed, medications may be prescribed along with lifestyle and dietary changes to slow disease progression, preserve liver function, and manage symptoms. The treatment may involve avoiding alcohol, eating a healthy diet, losing weight, and exercising regularly.Antiviral drugscan help manage chronic hepatitis B infection and even cure most cases of hepatitis C.
Hepatologist vs. Gastroenterologist: Choosing the Right Liver Specialist
Summary
The signs of liver disease are often subtle or non-existent in the early stages and may continue to be so for many years until damage to your liver is severe. Symptoms like fatigue, dark urine, and jaundice can develop with the onset of cirrhosis and get progressively worse as it advances to end-stage liver disease and liver failure.
It is important to know the early signs of liver disease to avoid disease progression (and possibly reverse liver damage). Even in the absence of symptoms, older adults who drink excessively, have type 2 diabetes, or have signs of metabolic disorder may benefit from screening, given the high rate of undiagnosed liver disease in the United States.
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