363x363px<unk>  can take quite a long time to develop, and symptoms may be slow to emerge. Some early symptoms include tiredness, weakness, loss of appetite, weight loss, and nausea. People may also feel discomfort in the right upper abdomen around the liver. As<unk>  progresses, symptoms can include neurological changes. This can consist of cognitive impairments, confusion, memory loss, sleep disorders, and personality changes. Worsening<unk>  can cause a build-up of fluid in different parts of the body such as the legs (edema) and abdomen (ascites). Other signs of advancing disease include itchy skin, bruising easily, dark urine, and yellowing of the skin. Liver dysfunction These features are a direct consequence of liver cells not functioning: * Spider angiomata or spider nevi happen when there is dilatation of vasculature beneath the skin surface. There is a central, red spot with reddish extensions that radiate outward. This creates a visual effect that resembles a spider. It occurs in about one-third of cases. The likely cause is an increase in estrogen.<unk>  causes a rise of estrogen due to increased conversion of androgens of androgens into estrogen. * Palmar erythema presents as reddish palms below the thumb and below little finger. This is seen in about 23% of<unk>  cases. This is a result of increased estrogen. * Gynecomastia, or the increase of breast size in men, is caused by increased estradiol (a potent type of estrogen). This can occur in up to two-thirds of cases. * Hypogonadism signifies a decreased functionality of the gonads. This can result in impotence, infertility, loss of sexual drive, and testicular atrophy. A swollen scrotum may also be evident. * Liver size can be enlarged, normal, or shrunken in people with<unk> . As the disease progresses, the liver will typically shrink due to the result of scarring. * Ascites is a build of fluid in the peritoneal cavity in the abdomen * Jaundice is the yellowing of the skin. It can additionally cause yellowing of mucous membranes notably of the white of the eyes. This phenomenon is due to increased levels of bilirubin, which may also cause the urine to be dark-colored. Portal hypertension Liver<unk>  makes it hard for blood to flow in the portal venous system. This resistance creates a backup of blood and increases pressure. This results in portal hypertension. Effects of portal hypertension include: upright=2 * An enlarged spleen in 35 to 50% of cases * Esophageal varices and gastric varices result from collateral<unk> culation in the esophagus and stomach (a process called portacaval anastomosis). When the blood vessels in this<unk> culation become enlarged, they are called varices. Varices are more likely to rupture at this point. Variceal rupture often leads to severe bleeding, which can be fatal. * Caput medusae are dilated paraumbilical collateral veins due to portal hypertension. Blood from the portal venous system may be forced through the paraumbilical veins and ultimately to the abdominal wall veins. The created pattern resembles the head of Medusa, hence the name. * Cruveilhier-Baumgarten bruit is bruit in the epigastric region (on examination by stethoscope). It is due to extra connections forming between the portal system and the paraumbilical veins. Other nonspecific signs Some signs that may be present include changes in the nails (such as Muehrcke's lines, Terry's nails, and nail clubbing). Additional changes may be seen in the hands (Dupuytren's contracture) as well as the skin/bones (hypertrophic osteoarthropathy). Advanced disease As the disease progresses, complications may develop. In some people, these may be the first signs of the disease. * Bruising and bleeding can result from decreased production of clotting factors * Hepatic encephalopathy (HE) occurs when ammonia and related substances build up in the blood. This build-up affects brain function when they are not cleared from the blood by the liver. Symptoms can include unresponsiveness, forgetfulness, trouble concentrating, changes in sleep habits, or psychosis. One classic physical examination finding is asterixis. This is the asynchronous flapping of outstretched, dorsiflexed hands. Fetor hepaticus is a musty breath odor resulting from increased dimethyl sulfide and is a feature of HE. * Sensitivity to medication can be caused by decreased metabolism of the active compounds * Acute kidney injury (particularly hepatorenal syndrome) * Cachexia associated with muscle wasting and weakness
Cirrhosis
Terry's nails
Hepatitis
Nephrotic syndrome  Nephrotic syndrome  1
Fatty liver disease
Alcoholic liver disease
Non-alcoholic fatty liver disease
Chronic liver disease