Liver disease: symptoms, causes, types and treatment

The NHS says most types of liver disease do not cause any symptoms in the early stages. NHS inform says liver disease does not usually cause obvious signs until it is fairly advanced, when possible symptoms include loss of appetite, weight loss and jaundice.

The NHS lists the symptoms of cirrhosis, the stage at which the liver is scarred, as feeling very tired and weak all the time, loss of appetite that may lead to weight loss, loss of sex drive, yellow skin and whites of the eyes (jaundice), itchy skin and feeling or being sick.

As cirrhosis gets worse, the NHS lists additional symptoms including bleeding or bruising easily, a swollen tummy, legs, ankles or feet, trembling hands, slurred speech, confusion or difficulty concentrating, vomiting blood and very dark or black poo. Men may also have larger breasts than usual or smaller testicles.

Liver disease is not one condition. NHS inform describes the liver as the second largest organ in the body, which fights infections, removes toxins such as alcohol, controls cholesterol, helps blood to clot and releases bile that breaks down fats.

Many conditions can damage it. NHS inform says all types of liver disease can lead to cirrhosis (scarring of the liver), not just alcohol-related liver disease, and that liver disease is on the increase in the UK.

The NHS lists common types of liver disease and their usual causes.

The NHS says cirrhosis is caused by long-term damage to the liver and that you may be more likely to have it if you regularly drink a lot of alcohol (over 50 units a week for men and over 35 units a week for women), have hepatitis B or C, live with obesity, have type 2 diabetes, have non-alcoholic fatty liver disease, have an autoimmune liver condition or have a genetic condition such as haemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency or cystic fibrosis.

The NHS says treatment depends on the type you have and how severe it is. Healthy lifestyle changes can help with some types, and alcohol-related liver disease may improve if you stop drinking alcohol. Some types, such as certain types of hepatitis, may need medicine. If you have severe damage and scarring (cirrhosis), you may need a liver transplant.

For cirrhosis, the NHS says it cannot be cured, but treatments can slow it down or stop it getting worse. This usually means treating the cause, for example with antiviral medicines for hepatitis B or C, and treating complications with medicines such as laxatives to remove toxins, beta blockers to reduce bleeding, medicines to reduce swelling and antibiotics for infections.

The NHS says you can reduce your risk of many types of liver disease by trying to maintain a healthy weight and not drinking too much alcohol. Vaccines are available for hepatitis A and hepatitis B and are recommended if you are at risk.

If you already have cirrhosis, the NHS advises a healthy balanced diet, regular exercise, a healthy weight, not drinking alcohol, not smoking, staying up to date with vaccinations such as the flu and pneumococcal vaccines, and checking with a pharmacist or doctor before taking any medicines, including herbal medicines.

The NHS says to see a GP if you think you might have liver disease or cirrhosis.

• If you have been diagnosed with cirrhosis, call 999 or go to A&E if you are vomiting blood, your poo is very dark or black, or you suddenly become confused or have slurred speech. Do not drive yourself.

• If you have cirrhosis, ask for an urgent GP appointment or call NHS 111 if your skin or the whites of your eyes look yellow, you have difficulty breathing or are more short of breath than usual, or you have a swollen tummy, legs, ankles or feet.

The NHS lists complications of cirrhosis including malnutrition, weak and fragile bones (osteoporosis), infections such as urinary tract infections and pneumonia, sepsis, jaundice, fluid building up in the tummy (ascites), confusion caused by changes in the brain, internal bleeding, liver failure, a blood clot in the vessel that brings blood to the liver, and liver cancer.

The NHS adds that how serious cirrhosis is depends on the cause and how early it is diagnosed and treated, and that many people with cirrhosis feel well and live for many years.

On the NHS, liver disease is usually suspected by a GP from your history and blood tests, often found when the tests are done for another reason, and confirmed with scans or specialist assessment by a liver specialist (hepatologist) or digestive system specialist (gastroenterologist). A dietitian and alcohol support services may also be involved.

Private liver clinics and gastroenterologists can offer blood tests, imaging and specialist review. Whichever route you take, ask which test established the cause, how scarring (fibrosis) was assessed and who will arrange long-term monitoring, since many liver conditions need regular checks even if you feel well.