Liver Health, Symptoms and Liver Disease

The liver is a large organ in the upper-right part of the abdomen. Its jobs include:

• processing nutrients from food
• helping control blood sugar and cholesterol
• producing bile to help digest fats
• removing alcohol, medicines and other harmful substances from the blood
• helping the blood clot
• storing vitamins, minerals and energy
• helping the body fight infection

A person can have significant liver damage before clear symptoms develop.

Symptoms can vary and may have causes unrelated to the liver. Possible warning signs include:

• unusual or persistent tiredness
• feeling generally unwell
• reduced appetite
• feeling sick or being sick
• losing weight without trying
• pain or discomfort underneath the ribs on the right side
• itchy skin
• yellow skin or yellowing of the whites of the eyes
• darker urine or paler poo
• swelling in the abdomen, legs, ankles or feet
• bruising or bleeding more easily
• confusion, poor concentration or unusual drowsiness

Yellowing of the skin may be harder to see on brown or black skin, but it may still be visible in the whites of the eyes.

These symptoms do not automatically mean someone has liver disease, but they should not be ignored.

Liver conditions include:

• metabolic dysfunction-associated steatotic liver disease, also called MASLD and previously known as non-alcoholic fatty liver disease or NAFLD
• alcohol-related liver disease
• hepatitis, including hepatitis A, B, C, D and E
• autoimmune hepatitis
• haemochromatosis, where too much iron builds up in the body
• cirrhosis, which is severe scarring of the liver
• liver cancer
• inherited and autoimmune liver conditions

The cause, seriousness and treatment differ for each condition. A healthcare professional must assess and diagnose the problem.

Fatty liver disease happens when fat builds up in the liver. It often causes no symptoms and may be discovered during blood tests or a scan arranged for another reason.

The condition is more common in people who:

• are overweight, particularly around the waist
• have type 2 diabetes
• have high blood pressure or high cholesterol
• are not very physically active
• have polycystic ovary syndrome

Most people have an early stage that does not cause serious damage. In some people, however, inflammation and scarring can develop and may eventually lead to cirrhosis.

Healthy lifestyle changes and medical monitoring can help prevent the condition from getting worse.

Drinking too much alcohol over time can damage the liver. Early liver damage may not cause symptoms.

The NHS advises people who drink alcohol not to regularly drink more than 14 units a week and to spread their drinking across three or more days.

Anyone who may be dependent on alcohol should seek medical advice before stopping suddenly. Alcohol withdrawal can be dangerous and may require medical support.

Hepatitis means inflammation of the liver. It can be caused by viruses, alcohol, certain medicines, autoimmune conditions or other health problems.

Some people have no symptoms. When symptoms occur, they may include:

• tiredness
• a high temperature
• loss of appetite
• feeling or being sick
• pain under the ribs on the right side
• itchy skin
• yellow skin or eyes
• dark urine and pale poo

The way viral hepatitis spreads depends on its type. Testing is important because some forms can cause long-term liver damage without producing early symptoms.

Cirrhosis is severe scarring caused by long-term liver damage. It can prevent the liver from working properly and may lead to internal bleeding, fluid retention, liver failure or liver cancer.

Possible causes include:

• alcohol-related liver disease
• hepatitis B or hepatitis C
• fatty liver disease
• autoimmune liver conditions
• certain inherited conditions

Cirrhosis cannot usually be reversed, but treating its cause and making recommended lifestyle changes may stop or slow further damage.

Anyone diagnosed with cirrhosis should remain under the care of their healthcare team and attend all monitoring appointments.

A GP may ask about symptoms, medicines, alcohol use, family history and other health conditions.

Tests may include:

• blood tests, including liver function tests
• an ultrasound scan
• CT or MRI scans
• a FibroScan or another test that measures liver stiffness
• tests for hepatitis or inherited conditions
• a liver biopsy in some cases

Abnormal liver blood-test results do not always show the cause or amount of liver damage. Further tests may be necessary.

Treatment depends on the cause and severity of the condition. It may include:

• healthy changes to food, weight and physical activity
• reducing or stopping alcohol with appropriate medical support
• medicines for hepatitis or autoimmune liver disease
• managing diabetes, blood pressure and cholesterol
• regular blood tests, scans or specialist appointments
• treatment for complications
• a liver transplant in severe cases

Do not start or stop prescribed medicines without professional advice.

Check with a doctor or pharmacist before using vitamins, supplements or herbal remedies. Some can interact with medicines or harm the liver.

You may find it helpful to ask:

• What could be causing my symptoms or abnormal test results?
• Do I need more blood tests or a scan?
• Is there any sign of liver inflammation, fibrosis or cirrhosis?
• Could any of my medicines or supplements affect my liver?
• Should I change how much alcohol I drink, and do I need help to do this safely?
• Do I need vaccinations against hepatitis A or hepatitis B?
• How often will I need monitoring?
• Should I be referred to a liver specialist?

Write down your symptoms, medicines and questions before the appointment.