The liver does not always present pain or obvious signs when compromised. This is a central challenge of liver diseases, as they can progress silently for years, allowing inflammation, fat accumulation, and fibrosis to advance without generating perceptible symptoms.
However, there are persistent indicators, although often ignored, that serve as alerts and justify medical investigation. The liver has a remarkable capacity for reserve and regeneration, which allows it to remain functional even in the face of existing problems.
EINSTEIN AGENCY
Lilian Curvelo, a gastroenterologist at Einstein Israelita Hospital, clarifies that many signs of liver diseases are generic and can be present in other conditions. For this reason, these signs should never be analyzed in isolation; they must be considered within the clinical context and individual risk factors. Waiting for more severe manifestations may compromise diagnosis and reduce the chances of halting the progression of the pathology.
One of the most common symptoms suggesting a possible liver problem is constant fatigue, without an identifiable cause. Although it is a symptom associated with various diseases, it can occur in individuals with chronic liver diseases, given that the liver plays crucial roles in energy metabolism, the modulation of inflammatory processes, and the elimination of substances from the body. Curvelo explains that in the presence of fibrosis or inflammation, the patient may experience disproportionate fatigue.
Another aspect requiring vigilance is the gradual increase in fat in the abdominal region. Although this is not a symptom directly caused by the liver, it is classified as a metabolic risk indicator. Excess visceral fat is linked to insulin resistance, type 2 diabetes, changes in cholesterol levels, and metabolic dysfunction-associated steatotic liver disease (MASLD), which constitutes one of the main causes of liver disease globally.
Skin changes can also signal health problems. Conditions such as persistent itching, extremely dry skin, redness on the palms of the hands, and dark spots in areas like the neck and armpits (known as acanthosis nigricans) may be related to liver dysfunction or metabolic diseases that frequently accompany fatty liver. Intense itching can indicate impaired bile flow, while acanthosis nigricans generally points to a state of insulin resistance.
Cognitive manifestations, on the other hand, are not always directly linked to liver problems. Difficulty concentrating, memory lapses, irritability, daytime sleepiness, sleep cycle inversion, and mental confusion can be indicative of hepatic encephalopathy, a complication observed in advanced liver diseases. The specialist warns that such symptoms require immediate medical evaluation.
Additionally, discomfort localized in the upper right quadrant of the abdomen, characterized by a feeling of heaviness or pressure under the ribs, especially after meals, may be associated with liver enlargement. This occurs in conditions such as steatosis, hepatitis, or hepatic congestion, although isolated abdominal pain is not sufficient to confirm a liver problem.
The organ can also present signs such as jaundice (yellowing of skin and eyes), dark urine, very light stools, swelling in the abdomen and legs, easy bruising, purple spots without apparent trauma, muscle loss, and unexplained weight loss. These scenarios require urgent medical evaluation, as they represent warning signs of a serious liver disease. It is essential to seek medical assistance when these signs are continuous or occur in people with abdominal obesity, diabetes, high cholesterol, hypertension, frequent alcohol use, or ingestion of medications and supplements with hepatotoxic potential.
To confirm or rule out a liver condition, the initial procedure involves blood tests that measure enzymes and other markers of liver function. However, in certain situations, these tests may be insufficient. Curvelo informs that someone may have fat or fibrosis in the liver even with normal liver enzymes, thus requiring complementary diagnostic tests using imaging, such as abdominal ultrasound, liver elastography, or specific tests to assess fibrosis.
There is a positive point, as many liver diseases can be controlled and, in some cases, even reversed when diagnosed early. In the case of fatty liver disease, for example, weight reduction, regular physical exercise, dietary improvement, and control of diabetes, cholesterol, and blood pressure help decrease liver fat, inflammation, and some fibrosis. In cases of viral hepatitis, current treatments allow for disease control, and in Hepatitis C, they enable the cure of the infection.
The Einstein physician concludes by warning that the liver rarely gives early warnings. Individuals with risk factors should undergo preventive evaluations, even if healthy, as early diagnosis is crucial for preventing disease progression.