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Signs and Symptoms of Liver Disease. Symptoms. Fatigue. Nausea. Occurs with more severe disease May be provoked by odours of food or fatty foods Poor appetite with weight loss – acute disease or advanced cirrhosis Diarrhoea only in severe jaundice - lack of bile acids in intestine.
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Symptoms Fatigue Nausea Occurs with more severe disease May be provoked by odours of food or fatty foods Poor appetite with weight loss – acute disease or advanced cirrhosis Diarrhoea only in severe jaundice - lack of bile acids in intestine • Most common and characteristic symptom of liver disease • Usually occurs on exercise or activity • “Liver pain” • Due to stretching or irritation of capsule • Severe pain in liver abscess or severe veno occlusive disease – occasionally in acute hepatitis Upper Right Quadrant Ache
Symptoms Itching/Pruritis Jaundice Usual progression: Darkened urine Scleralicterus Jaundice in skin Pale stools + steatorhea Undetectable til 2.5mg/dL If no dark urine: Indirect (unconjugated) hyperbilirubinaemia Eg in haemolytic anaemia or genetic condns of bilirubin conjugation • In acute liver disease: • Early in obstructive jaundice • Later in hepatocellular disease (acute hepatitis) • In chronic liver disease: • Usually presenting symptom in cholestatic disease (before jaundice)
Signs • Hepatomegaly • Congestion, inflammation, steatosis • Haemochromatosis, amyloidosis and many more • Hepato-shrinkaly aka cirrhotic liver • Fibrosis of the liver
Oestrogen related signs • Palmer erythema • Gynaecomastia • Spider naevi • Testicular atrophy and body hair loss
Signs in the hands • LeuconychiaTotalis – due to hypoalbuminaemia • Koilonychia – secondary to iron deficiency anaemia • Dupuytren’s Contracture – cause unknown • Clubbing
Signs of portal Hypertension • Ascites – Sequestration of fluid in abdomen due to increased pressure • Worsened by increased fluid retention in kidneys due to increased aldosterone and renin • Caput medusa – distended, engorged paraumbilical veins – radiating from umbilicus (flow towards legs) • Oesophageal varices – collateral portal blood flow through vessels in stomach and oesophagus • Splenomegaly – congestion of red pulp
Malnutrition issues in liver disease • Wasting – once cirrhotic, pt becomes more catabolic, depriving them of essential nutrients eg protein, causing muscle breakdown. • Weight loss also occurs due to increased catabolic state, causing lipolysis • Multiple factors contribute to malnutrition • Poor dietary intake • Alterations in nutrition absorption • Alteration in protein metabolism • One of most important factors influencing mortality and morbidity in end stage liver disease
Signs of Hepatic encephalopathy • Damage to neurons due to livers inability to metabolise ammonia to urea • Brain oedema with swelling of grey matter • May result in cerebral herniation • Progression of S&S: • Forgetfulness, irritability, mild confusion • Inverted sleep/wake cycle, trouble, issue with coordination, marked irritability • Altered consciousness, asterexis(disappears as somnolence worsens), disorientation, amnesia, hyperreflexia • Seizures, coma, death