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You may only associate your liver with breaking down alcohol, but this organ—the largest in the body—plays a role in more than 500 vital functions. These include producing a fluid called bile that helps with digestion, processing sugar to be stored for energy, and regulating amino acids, which we need to build muscle. So if something with it goes wrong, various aspects of your health can be impacted.
Roughly 4.5 million Americans have been diagnosed with some form of liver disease, which is a broad term for any condition that affects the organ. Generally, symptoms don’t crop up unless the issue is advanced, so millions are unaware they're sick. “The liver is an amazing organ: It can take a lot of injury and inflammation before the scarring gets so bad that it starts to fail and patients notice changes to their health,” explains Jennifer Lai, MD, a general and transplant hepatologist at the University of California San Francisco’s Department of Medicine.
But that doesn’t mean you can’t catch liver disease before it’s too late. If you notice any potential signs, make an appointment with your primary care provider. The disease may already be advanced, but treatments might make you more comfortable or slow the progression of your condition. These are the red flags to keep on your radar.
1. You’re constantly drained.
More than 50% of people with chronic liver disease experience ongoing lethargy, with some conditions causing worse symptoms than others. For example, both fatty liver disease and primary biliary cholangitis (PBC), an autoimmune disease that affects the bile ducts in the liver, often cause extreme fatigue. This is defined as exhaustion that significantly impairs your quality of life. In other words, it’s not just run-of-the-mill sleepiness, like how you might feel after a late night out. “It’s really debilitating and very, very hard to treat,” Dr. Lai says. Symptoms often include muscle weakness, brain fog, memory impairment, and, to make matters worse, poor sleep quality.
It’s unclear why this happens, though Dr. Lai says researchers have some guesses. “First, liver disease is associated with chronic systemic inflammation, which can lead to low energy and fatigue,” she says. The other potential reason crops up once the condition advances. At this stage, the liver can struggle to clear toxins from the body, allowing them to travel to the brain and cause symptoms like fatigue and fogginess, Dr. Lai explains.
Related: Constant Fatigue? Here's When to See a Doctor If You're Tired All the Time
2. Your skin and eyes look yellow.
Liver conditions are chronic, which means that changes in your body generally occur slowly over a long period of time. No matter the stage, if you treat the condition ASAP, you can head off further problems. However, if it goes unmanaged, the liver cells can get inflamed and scarred, Dr. Lai says. “This ultimately leads to cirrhosis, where the liver is in failure and stops working,” she explains.
When cirrhosis sets in, Dr. Lai says people often develop jaundice, which is yellowing of eyes and skin. This occurs because bile builds up in the blood, which contains a yellow waste substance called bilirubin.
3. Your entire body is itchy.
Another symptom of advanced liver disease, particularly PBC and hepatitis C, is itching. Liver disease often damages the bile ducts, which causes a compound called bile salt to build up in the blood. This can irritate the nerves in the skin, causing that can’t-stop-scratching sensation all over the body, though it generally starts in the palms and soles before spreading. Dr. Lai notes that many of her patients can’t sleep because their symptoms are so distracting and uncomfortable. So if you have an itch you just can’t scratch, you should definitely ask your doctor if they think an issue with your liver may be the cause. You should also find out if they can prescribe you medication to manage the itching and improve your quality of life.
Related: How to Actually Resist the Urge to Scratch Itchy Skin
4. You’re never hungry anymore.
Many liver conditions can cause cirrhosis, including PBC and hepatitis. As a side effect, you may experience abdominal pain and elevated leptin levels, the hormone that suppresses appetite. Plus, let’s face it, you simply may not feel that great, Dr. Lai says. So don’t be surprised if you’re less hungry than usual.
5. You have red and purple marks on your skin.
Not to be confused with spider veins, spider angiomas are small purple and red spots just beneath the skin's surface that collect in a pattern that resembles the body and legs of a spider.
They're typically painless and most often appear on the chest, face, neck, and arms. Think you may have one? Press on it and watch what happens. Spider angiomas will often disappear and then come back when pressure is released.
Though there are many reasons that people with liver disease may develop this skin condition, changes in hormonal levels are one of the leading causes. “Cirrhosis is associated with higher levels of estrogen, [which] stimulates the enlargement of blood vessels, especially at the surface of the skin,” Dr. Lai explains. For this reason, these skin marks are also common in people who are pregnant.
How to catch liver disease early
Since liver disease has no noticeable symptoms in the early stages, the best thing you can do is proactively get tested. “It can be caught very early with routine bloodwork,” Dr. Lai says. Early diagnosis may prevent damage to the organ and, in some cases, slow the progression of the condition.
At your next annual exam with your primary care doctor, ask for a comprehensive metabolic panel (CMP). This routine blood test is generally covered by insurance and measures various chemicals, several of which can indicate if something is wrong with your liver. If your results show elevated levels of alkaline phosphatase (one of the liver enzymes), your doctor may refer you to a hepatologist for further testing. You may be given a liver ultrasound to be sure there aren’t any masses in the organ and to ensure that the larger bile ducts aren’t entirely blocked. Alternatively, you may be checked for gallstones, which can sometimes elevate alkaline phosphatase levels.
As your doctor works to understand why your bloodwork indicates a possible issue, they’ll likely ask you questions about your lifestyle. They may want to know about the supplements you’re taking, as some can damage the liver, or inquire about your alcohol use. Definitely be honest when you answer—your doctor isn’t trying to police you. They’re trying to help. “If you say one drink a week, but it’s really two a night, then all of the changes in your liver could be from your alcohol use [as opposed to a separate health issue],” Dr. Lai says. If you fudge the truth, you may face unnecessary tests as your doctor works to try and diagnose what’s happening. “Once you know the diagnosis, you can implement treatment to prevent ongoing damage to the organ and ultimately failure of the liver,” Dr. Lai says.
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