Liver

Overview

Your liver is a large organ in the upper right part of your tummy, just under your ribs. It weighs about the same as a bag of sugar and you cannot live without it. It does hundreds of jobs: it cleans your blood, makes bile to help digest fatty food, stores sugar for energy, helps your blood to clot, and fights infection. When doctors talk about liver disease, they mean any condition that damages liver cells or blocks the small tubes, called bile ducts, that carry bile out of the liver. Damage often builds up slowly over years, which is why liver problems can go unnoticed for a long time.

Yes. Liver problems are among the most common health issues worldwide. Fatty liver disease alone is thought to affect about 1 in 4 adults around the world, and it is becoming more common as obesity and type 2 diabetes rise. Alcohol-related liver disease and viral hepatitis are also widespread.

Anyone can have liver problems, at any age. Some are more common in people who drink a lot of alcohol, carry extra weight around the middle, or have type 2 diabetes. Others affect people born with certain genes, people with autoimmune conditions (where the body's defence system mistakenly attacks its own tissues), and people exposed to hepatitis viruses. Some liver problems affect babies and children, and some treatments work differently in older adults.

Symptoms

Common symptoms

• Often no symptoms at all, especially in the early stages
• Feeling tired or low on energy
• A dull ache or heaviness in the upper right side of the tummy
• Feeling sick or off your food
• Losing weight without trying
• Yellowing of the skin or the whites of the eyes (jaundice)
• Dark urine and pale, putty-coloured stools
• Itchy skin
• Bruising or bleeding more easily than usual
• Swelling of the tummy or ankles
• Feeling foggy, forgetful or unusually sleepy

Symptoms in children

• Yellow skin or eyes (jaundice) that lasts more than two weeks in a newborn
• Pale or chalky stools and dark urine
• Poor feeding and slow weight gain
• Being very sleepy or very irritable
• Itchy skin, or scratch marks from scratching
• A swollen tummy
• Fatty liver is being seen more often in children with obesity. It usually causes no symptoms and is often found by chance on a blood test or scan

Symptoms in older adults

• Symptoms can be vaguer: tiredness, poor appetite, weight loss, or just feeling generally unwell
• Confusion, forgetfulness or drowsiness can be an early sign of liver problems in older people
• Jaundice may appear later, once damage is more advanced
• Older adults often take several medicines, which can put more strain on the liver. Ask your doctor or pharmacist to review your medicines regularly

Causes

Main causes

• Alcohol-related liver disease: from drinking more than the liver can safely cope with over time
• Fatty liver disease: extra fat stored inside liver cells, linked to excess weight, type 2 diabetes and high blood fats
• Viral hepatitis B and C: infections that inflame the liver and can become long-term
• Autoimmune liver conditions: where the immune system mistakenly attacks the liver or the bile ducts
• Inherited conditions: such as haemochromatosis (too much iron stored) or Wilson disease (too much copper stored)
• Medicines, herbal remedies and supplements: some can harm the liver, especially in large doses or when mixed together
• Blocked bile ducts: for example from gallstones or a narrowed duct
• Less common causes: including some cancers, heart failure affecting the liver, and sudden severe illness

Risk factors

• Drinking alcohol regularly above recommended limits
• Carrying extra weight, particularly around the waist
• Type 2 diabetes or high cholesterol
• Long-term hepatitis B or C infection
• A family history of liver disease or inherited liver conditions
• Taking several medicines, or herbal supplements, without checking with a pharmacist
• Injecting drugs and sharing needles, or tattoos and piercings done with unsterile equipment
• Unprotected sex with someone who has hepatitis B or C
• Smoking

When to see a doctor

See a doctor urgently if:

• See a doctor the same day, or call your local health service for advice, if you notice any of these:
• New yellowing of your skin or the whites of your eyes
• Dark urine together with pale stools
• A swollen tummy or swollen ankles that has come on quickly
• Fever together with yellow skin or eyes
• Severe itching that keeps you awake
• Bruising or bleeding that is new or that you cannot explain
• Feeling unusually sleepy, foggy or muddled

Book a routine appointment if:

• You have felt tired, itchy, or uncomfortable in the upper right tummy for more than a few weeks
• You have risk factors such as heavy drinking, type 2 diabetes, or a family history of liver disease
• A blood test has shown changes in your liver tests
• You would like help to cut down on alcohol
• You want to check whether a medicine, supplement or herbal product is safe for your liver

Diagnosis

Your GP will start by asking about your health, your drinking, your medicines and your family history, and will examine your tummy. Blood tests are usually the first step. Depending on the results, you may have a scan or be referred to a liver specialist (a doctor who focuses on liver conditions). Most liver conditions can be diagnosed without any need for an operation.

Tests that may be done

• Liver blood tests: a standard blood test that shows whether the liver is irritated or not working as it should
• Full blood count and clotting tests
• Blood tests for hepatitis B and C
• Ultrasound scan: a painless scan that shows the shape of the liver and looks for gallstones or extra fat
• FibroScan or elastography: a quick, painless test that measures how stiff the liver is, which shows scarring
• MRI or CT scan: more detailed pictures, if needed
• Endoscopy: a camera test to check the food pipe for swollen veins, if cirrhosis is suspected
• Liver biopsy: a small sample of liver tissue, used only when other tests leave questions

What to expect at your appointment

Most tests are quick and painless. You may need to avoid eating for a few hours before an ultrasound or scan. Results usually come back within days to a couple of weeks. It can take more than one appointment to be sure what is going on, and you may be offered repeat tests over months to see how things change. Write down your questions beforehand, and take someone with you if that helps.

Treatment

Treatment depends on what is causing the problem. The first goal is always to remove or control the cause so the liver can repair itself. That might mean cutting out alcohol, losing some weight, treating a viral infection, or stopping a medicine that is not helping. Alongside this, the aim is to keep you well: managing symptoms, protecting the liver from further harm, and checking in regularly.

Self-care at home

• Stop drinking alcohol. This is the single most powerful step for most liver conditions, and support is available if you need it
• If you carry extra weight, aim to lose it slowly and steadily. Even a modest loss helps
• Eat a balanced diet with plenty of vegetables, fruit, whole grains and protein
• Move more: build up gradually towards about 150 minutes of moderate activity a week if you can
• Check every medicine, herbal remedy and supplement with your pharmacist before taking it
• Keep your appointments and repeat blood tests, as they show how well you are doing
• Get plenty of rest, and tell your doctor if you feel low or anxious

Medical treatments

Doctors treat liver problems in different ways depending on the cause. For viral hepatitis, there are treatments that can clear or control the infection. For autoimmune liver disease, treatment aims to calm the immune system. For inherited conditions such as too much iron, treatment removes the extra iron. Other treatments help with symptoms and complications: for example, medicines to ease itching, tablets that help the body get rid of extra fluid, vitamins and nutrition support, and treatment for confusion. Your specialist will explain which approach suits you, along with the benefits and risks. Never start, stop or change any medicine without talking to your doctor or pharmacist first.

When is surgery considered?

Surgery or procedures are only needed for some liver problems. Examples include removing a gallstone that is blocking a bile duct, widening a narrowed duct using a camera procedure, removing part of the liver for certain tumours, or a liver transplant when the liver has stopped working properly. A transplant is a big step, and specialist teams assess carefully whether it is right for you. Many people live well for years with monitoring and treatment and never need surgery.

Living with this condition

Many people live full, normal lives with a liver condition. Day to day, that usually means keeping a steady routine: taking any prescribed treatment, going to check-ups, avoiding alcohol, eating reasonably well, and noticing how you feel. Keep a simple record of new symptoms and any medicines you start, so you can talk them through at your next appointment.

Lifestyle tips

• Stay alcohol-free if your liver is damaged. No amount is guaranteed safe
• Keep to a healthy weight and waist size
• Stay active in a way you enjoy
• Get enough sleep, and rest when you feel tired
• Keep up with any vaccinations your doctor recommends
• Never share needles, and make sure tattoos and piercings are done in licensed, sterile places
• Use condoms with new partners if there is any risk of hepatitis
• Ask your pharmacist before taking any new medicine, supplement or herbal product

Diet and exercise

There is no special liver diet, but a healthy pattern helps. Fill your plate with vegetables, fruit, beans, whole grains and lean protein. Cut back on sugary drinks, sweets and highly processed foods. If your doctor has told you to watch salt because of fluid build-up, keep salty foods to a minimum. Coffee (plain, without lots of sugar) has been linked with better liver health in some studies. For exercise, choose something you will keep doing: walking, swimming, cycling or dancing. Start where you are and build up slowly. If you feel very tired, shorter sessions more often may suit you better than one long one.

Mental health and emotional wellbeing

Being told you have a liver problem can bring worry, low mood and fatigue. Some people also feel judged, especially if alcohol is part of the story. That judgement is unfair, and you deserve support rather than blame. Talk to your GP if you feel anxious or low, as talking therapies and support groups can help a lot. If you ever have thoughts of harming yourself or ending your life, contact your local emergency number or a crisis helpline in your country straight away. You are not alone, and help is available.

Prevention

Many, though not all, liver problems can be prevented or made much less likely. Alcohol-related and fatty liver disease are strongly linked to things you can change. Viral hepatitis can be prevented with vaccination, safer sex and safe injecting. Inherited liver conditions cannot be prevented, but they can be found early and managed well.

Vaccines

Safe and effective vaccines are available for hepatitis A and hepatitis B. In many countries they are part of routine childhood vaccinations. Ask your doctor or pharmacist whether you should have them, for example if you travel to certain areas, work in healthcare, already have a liver condition, or are at risk through sex or drug use. There is no routine vaccine for hepatitis C, but it can usually be cured with treatment.

Screening programmes

There is no general liver screening test for everyone. Doctors usually offer liver blood tests to people with risk factors such as heavy drinking, type 2 diabetes, obesity or a family history of liver disease. Testing for hepatitis B and C is recommended for people at higher risk, and pregnant women are usually tested for hepatitis B. If you are unsure whether you need testing, ask your GP.

Complications

If left untreated

• Scarring of the liver (fibrosis), which can progress to cirrhosis
• Liver failure, where the liver stops doing its jobs properly
• Swollen veins in the food pipe that can bleed dangerously
• Fluid building up in the tummy and legs
• Confusion and drowsiness caused by waste products building up (hepatic encephalopathy)
• Liver cancer, which is more likely in people who already have cirrhosis
• Kidney problems and serious infections
• These problems usually develop slowly over years, which is exactly why early action matters

Long-term outlook

The outlook is often much better than people fear. The liver is one of the few organs that can repair and even regrow itself. If damage is caught early and the cause is tackled, many people recover or stay stable for decades. Even with cirrhosis, good care, regular checks and healthy habits can help people live well for a long time. Try to focus on the next small step rather than the whole picture at once.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.