The classic symptoms of liver damage include the following:
I. Pale stools occur when stercobilin, a brown pigment, is absent from the stool. Stercobilin is derived from bilirubin metabolites produced in the liver.
II. Dark urine occurs when bilirubin mixes with urine
III. Jaundice (yellow skin and/or whites of the eyes) This is where bilirubin deposits in skin, causing an intense itch. Itching is the most common complaint by people who have liver failure. Often this itch cannot be relieved by drugs.
IV. Swelling of the abdomen, ankles and feet occurs because the liver fails to make albumin.
V. Excessive fatigue occurs from a generalized loss of nutrients, minerals and vitamins.
VI. Bruising and easy bleeding are other features of liver disease. The liver makes substances which help prevent bleeding. When liver damage occurs, these substances are no longer present and severe bleeding can occur.
VII. Pain in the upper right quadrant can result from the stretching of Glisson’s capsule in conditions of hepatitis and pre-eclampsia.
The diagnosis of liver disease is made by liver function tests, groups of blood tests, that can readily show the extent of liver damage. If infection is suspected, then other serological tests will be carried out. Sometimes, an ultrasound or a CT scan is needed to produce an image of the liver.
Physical examination of the liver can only reveal its size and any tenderness, and some form of imaging will also be needed.
Axial CT image showing anomalous hepatic veins coursing on the subcapsular anterior surface of the liver.
Maximum intensity projection (MIP) CT image as viewed anteriorly showing the anomalous hepatic veins coursing on the anterior surface of the liver.
Lateral MIP view in the same patient.
A CT scan in which the liver and portal vein are shown.