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 group | Typical picture | Pathogenesis |
|---|---|---|
| Fatigue | Early, persistent | Impaired hepatocyte energy metabolism |
| GI | Anorexia, nausea, RUQ ache | Capsular stretch from hepatomegaly |
| Jaundice | Yellow skin/sclera | Reduced bilirubin uptake/conjugation |
| Bleeding | Spider naevi, epistaxis, melaena | Decreased clotting-factor synthesis |
| Ascites/oedema | Distended abdomen, pitting ankle oedema | Portal hypertension + hypoalbuminaemia |
| Neuro-psychiatric | Drowsiness, disorientation | Elevated ammonia & toxins |
| Renal | Oliguria, rising urea | Hepatorenal syndrome |