What are the signs that your liver is not working properly?

The liver is a vital organ that performs many essential functions in the body. When the liver is not working properly, it can lead to a condition called liver disease. Some signs that may indicate your liver is unhealthy include:


One of the most common signs of liver disease is jaundice, which causes a yellowish discoloration in the skin and eyes. Jaundice occurs when there is a buildup of bilirubin in the blood. Bilirubin is a yellow-orange bile pigment that is formed during the normal breakdown of red blood cells. The liver helps to process and eliminate bilirubin from the body. When the liver is not working correctly, bilirubin can accumulate and cause jaundice.

Itchy Skin

Itching is another sign that may point to liver disease. Itching typically starts on the palms of the hands and soles of the feet but can spread to other parts of the body. The itching is caused by a buildup of bile salts under the skin that occurs when the flow of bile is obstructed by liver damage. The medical term for this itching is pruritus.

Swelling and Fluid Retention

As the liver becomes increasingly damaged, it may lose its ability to produce albumin and other proteins that maintain the proper balance of fluid in the body. This can result in swelling (edema) in the legs, feet, ankles, and abdomen. Fluid may also accumulate in the abdomen, a condition called ascites that causes abdominal swelling.

Loss of Appetite and Unintentional Weight Loss

liver disease often causes a loss of appetite and feelings of fullness after eating only a small amount. This can lead to significant unintentional weight loss over time. Poor nutrient absorption caused by liver dysfunction can also contribute to weight loss.

Nausea and Vomiting

The liver plays an important role in digesting food and metabolizing nutrients. When the liver is diseased, it may not properly process waste products, leading to a buildup of toxins in the blood. This can cause nausea and vomiting. Vomiting may also occur from portal hypertension, which is increased pressure in the portal vein that brings blood from the intestines to the liver.

Abdominal Pain and Bloating

Liver inflammation and scarring from chronic liver disease can cause a dull, aching pain in the upper right abdomen. Bloating can also occur from fluid retention and abdominal swelling (ascites) associated with advanced liver disease.

Chronic Fatigue and Weakness

Damaged livers may not properly store and release energy from glycogen, resulting in unexplained fatigue and weakness. Toxins accumulating in the body can also cause lack of energy. Low red blood cell counts (anemia) that sometimes accompanies liver disease can also cause weakness and fatigue.

Bleeding Problems

The liver produces proteins called clotting factors that help the blood clot properly. When liver function is impaired, blood may not clot as it should. This can lead to easy bruising, recurrent nosebleeds, bleeding gums, and blood in the stool or vomit.

Confusion and Impaired Brain Function

A failing liver is unable to properly metabolize and clear toxins from the bloodstream. These toxins can build up in the blood and impair brain functioning, leading to confusion, slow thinking, slurred speech, and forgetfulness. This condition is called hepatic encephalopathy.

Spider-like Blood Vessels on Skin

Some people with liver disease develop spider-like blood vessels on their skin that are visible. These vascular lesions usually first show up on the upper body and are a distinctive sign of liver damage.

High Blood Pressure in Leg Veins

When the liver is badly scarred, it can cause increased pressure in the portal vein bringing blood from the intestines and spleen to the liver. This pressure backs up into veins in the leg and abdominal wall. A swollen spleen may also contribute to high venous pressure.


Many people with cirrhosis and other advanced liver disease also have gallstones. Gallstones form when there is an imbalance between blood levels of cholesterol and bile salts that are influenced by liver function.

Rash and Itching Hives

In some cases, liver disease can trigger non-itchy hives or a generalized itchy rash on the skin. The rash may come and go and typically first appears on the arms and legs.

Fingernail Changes

With prolonged liver disease, the nails may develop white spots called leukonychia or become brittle and prone to breaking. In some cases the nails may also curve downward.

Breast Enlargement in Men

Male breast enlargement (gynecomastia) can occur when liver dysfunction allows testosterone to be metabolized into estrogen. The excess estrogen leads to increased breast tissue growth.

Irregular Periods in Women

Hormonal changes related to liver disease can cause irregular menstrual cycles in women. Periods may become lighter, heavier, more or less frequent, or disappear altogether.

Decreased Libido and Impotence

Damage to the liver cells can lower testosterone levels in men, leading to reduced sex drive and impotence. Decreased estrogen levels in women from liver disease can also reduce sexual desire.

Changes in Urine Color

When bilirubin levels are very high, the excess bilirubin may be excreted out in urine resulting in dark brown or orange colored urine. Pale urine can also occur from low red blood cell counts related to liver disease.

Fever and Night Sweats

Some types of liver disease like autoimmune hepatitis and acute hepatitis infections can cause episodes of fever along with drenching night sweats that require changing sleepwear.

Causes of Liver Disease

There are many possible causes of liver dysfunction leading to the signs and symptoms described above. Common causes include:

  • Viral hepatitis infections from hepatitis viruses A, B, C, D, and E.
  • Excess alcohol consumption that can lead to alcoholic liver disease.
  • Nonalcoholic fatty liver disease, a buildup of fat in liver cells that is associated with obesity.
  • Autoimmune disorders where the immune system attacks liver cells, such as autoimmune hepatitis.
  • Metabolic disorders that impair liver function, like hemochromatosis and Wilson’s disease.
  • Medications and supplements that can damage the liver as a side effect.
  • Exposure to toxins like pesticides, herbicides, and industrial chemicals.
  • Congenital defects of the bile ducts like primary biliary cirrhosis.
  • Right-sided heart failure leading to congestion of the liver.
  • Blocked blood flow through the liver from blood clots or portal vein thrombosis.

Many cases of liver disease develop slowly and progress over years leading to scarring of liver tissue known as cirrhosis. Some causes like viral hepatitis or reactions to medications can also result in acute liver injury occurring rapidly.

Diagnosing Liver Disease

If signs and symptoms suggest a possible liver problem, your doctor will examine you and run certain tests to check how well your liver is working. Common diagnostic tests include:

  • Physical exam checking for jaundice, fluid buildup, abdominal tenderness, liver enlargement.
  • Blood tests measuring liver enzymes like ALT and AST to detect liver inflammation. Also tests bilirubin levels.
  • Imaging tests like ultrasound, CT, or MRI scans to evaluate the liver size, shape, structure.
  • Liver biopsy taking a tissue sample for examination under a microscope.
  • Specialized tests to look for specific viruses, antibodies, and genetic mutations.

Based on the test results and examination, your doctor can determine if you have liver disease and identify the likely cause. Early diagnosis and treatment are important to prevent permanent liver damage.

Treatment Options for Liver Problems

Treatment depends on the specific type and stage of liver disease but may involve:

  • Medications like corticosteroids, immune suppressants, antiviral drugs.
  • Supplements to provide missing nutrients when the liver cannot metabolize nutrients properly.
  • Procedures such as endoscopic band ligation for esophageal varices or paracentesis for draining ascites.
  • Surgery such as a liver transplant if liver failure is advanced and life threatening.
  • Lifestyle changes including abstinence from alcohol, eating a healthy diet, and weight loss.

Addressing the underlying cause of liver damage is key. Treatment also focuses on managing complications of end-stage liver disease. Consult a hepatologist (liver specialist) to determine the best treatment options for your individual situation.

Prevention Tips

You can lower your risk of developing liver problems by:

  • Getting vaccinated against hepatitis A and B viruses
  • Avoiding unnecessary medications known to be toxic to the liver
  • Avoiding exposure to industrial chemicals and environmental toxins
  • Practicing safe sex to avoid sexually transmitted infections
  • Limiting alcohol intake or avoiding alcohol completely if you already have liver disease
  • Maintaining a healthy weight through diet and exercise

When to See a Doctor

Consult your doctor promptly if you have any persistent signs of possible liver disease, especially jaundice, abdominal swelling, itching, easy bruising, or bleeding. Make sure you inform your doctor about all medications and supplements you are taking, as these may contribute to liver problems. Seek emergency care if you develop severe abdominal pain, vomiting blood, confusion, or dark urine or stool.

Take-Away Points

  • Common signs of unhealthy liver function include jaundice, itching, swelling, nausea, fatigue, and mental fogginess.
  • Underlying causes include hepatitis virus infections, alcohol abuse, autoimmune disease, and metabolic disorders.
  • See your doctor right away if you notice any symptoms or have risk factors for liver disease.
  • Diagnostic tests like liver enzyme blood tests, imaging scans, and sometimes liver biopsy can confirm liver disease.
  • Treatment aims to control liver disease progression and manage complications.
  • Lifestyle changes and addressing underlying causes are key to improving liver health.

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