Patients often present with features linked to impaired hepatic metabolism and inflammation: Oliguria, rising creatinine: hepatorenal syndrome Fatigue: earliest and most common, easily overlooked Anorexia, nausea, vomiting: lead to weight loss Dull or dragging right upper quadrant pain: enlarged liver stretches Glisson capsule Jaundice: yellow skin/sclera indicate cholestasis Low-grade fever: cytokine-driven Ascites, leg edema: portal hypertension plus hypoalbuminaemia Spider naevi, palmar erythema: failed oestrogen clearance Confusion, somnolence: early hepatic encephalopathy Haematemesis, melaena: ruptured oesophageal/gastric varices Symptom groupTypical picturePathogenesisFatigueEarly, persistentImpaired hepatocyte energy metabolismGIAnorexia, nausea, RUQ acheCapsular stretch from hepatomegalyJaundiceYellow skin/scleraReduced bilirubin uptake/conjugationBleedingSpider naevi, epistaxis, melaenaDecreased clotting-factor synthesisAscites/oedemaDistended abdomen, pitting ankle oedemaPortal... Learn more