The signs and symptoms of liver disease can be determined either by the liver disease itself or by the complications of the disease; for example, the portal hypertension syndrome- a complication of cirrhosis may determine acute GI bleeding. The most common signs and symptoms of liver disease are: jaundice, right upper quadrant pain, abdominal distension, fatigue, intestinal bleeding, and itching. Fever may occur in viral (most common) or alcoholic hepatitis. Jaundice (the yellow pigmentation of sclerae, mucous membranes and skin) is the most common feature of liver disease, and many hepatologists consider it to be a very reliable marker of severity. Many patient observe the darkening of the urine before the noticing the pigmentation of sclerae. Jaundice is accompanied in many cases by steatorrhea (fatty stools) and the lightening of the colour of the stool, due to cholestasis.
Right upper quadrant pain is caused by the extension of liver's capsule (which is very rich in nerve endings) and it is another common feature of liver disease. Right upper quadrant pain is usually accompanied by hepatomegaly. Due to the variability in size and shape of the liver hepatomegaly is not a very reliable feature of liver disease. Hepatomegaly is a typical finding in alcoholic hepatitis, cirrhosis, amiloidosis, venoocclusive disease and liver cancer.
In acute liver disease itching may occur. Itching appears early in obstructive jaundice and later in acute hepatitis. It may also occur in chronic cholestatic liver diseases such as primary biliary cirrhosis and sclerosing cholangitis.
The physical examination also shows palmar erythema and spider angiomata in both acute and chronic disease, but they are not very reliable signs since they can occur in normal individuals, especially during pregnancy. Spider angiomata are visible, superficila, tortuous arteries which occur only on the face, arms, and upper torso.
In advanced liver disease the signs are more proeminent including edema, muscle wasting, bruising and weight loss. Other signs of advanced liver disease are:umbilical hernia caused by ascites, hydrothorax and caput medusa- proeminent collateral veins radiating from the umbilicus. Severe cirrhosis and portal hypertension may lead to hepatopulmonary syndrome which consists in liver disease, pulmonary arteriovenous shunting and hypoxemia.
Skin changes may also occur in liver disease. Hyperpigmentation is typical in chronic conditions such as primary cirrhosis and sclerosing cholangitis. Mucocutaneous vasculitis is a common feature of cryoglobulinemia in chronic hepatitis C but it can also appear in chronic hepatitis B.