Liver pain

What is liver pain

The liver is the largest gland in the body, weighing about 1.4 kg (3 pounds) in an average adult. Amazingly versatile, it performs over 500 functions. Its digestive function is to produce bile, a green alkaline liquid that is stored in the gallbladder and secreted into the duodenum. Bile salts emulsify fats in the small intestine; that is, they break up fatty nutrients into tiny particles, just as dish detergent breaks up a pool of fat drippings in a roasting pan. These smaller particles are more accessible to digestive enzymes from the pancreas. The liver also performs many metabolic functions. The liver:

• Picks up glucose from nutrient-rich blood returning from the alimentary canal and stores this carbohydrate as glycogen for subsequent use by the body.
• Processes fats and amino acids and stores certain vitamins.
• Detoxifies many poisons and drugs in the blood.
• Makes the blood proteins.
• It breaks down and stores many of the nutrients absorbed from the intestine that your body needs to function. Some nutrients must be changed (metabolized) in the liver before they can be used for energy or to build and repair body tissues.
• It makes most of the clotting factors that keep you from bleeding too much when you are cut or injured.
• It secretes bile into the intestines to help absorb nutrients (especially fats).
• It breaks down alcohol, drugs, and toxic wastes in the blood, which then pass from the body through urine and stool.

Almost all of these functions are carried out by a type of cell called a hepatocyte or simply a liver cell.

Figure 1. Location of the human liver

Where is liver pain

The liver is in the right upper quadrant of the abdominal cavity, just inferior to the diaphragm in the right superior part of the abdominal cavity and under your right ribs just beneath your right lung – filling much of the right hypochondriac and epigastric regions and extending into the left hypochondriac region. The liver is partially surrounded by the ribs, and extends from the level of the fifth intercostal space to the lower margin of the right rib cage, which protects this highly vascular organ from blows that could rupture it. The liver is shaped like a wedge, the wide base of which faces right and the narrow apex of which lies just inferior to the level of the left nipple.

Therefore if you have a liver problem, you may have “liver pain”  or discomfort in the upper right side of your abdomen (right upper quadrant).

Figure 2. Quadrants of Abdomen

Liver pain symptoms

There are many kinds of liver diseases and conditions. Some, like hepatitis, are caused by viruses. Others can be the result of drugs or drinking too much alcohol. Long-lasting injury or scar tissue in the liver can cause cirrhosis. Jaundice, or yellowing of the skin, can be one sign of liver disease.

Some liver diseases may cause no pain, whilst other may cause liver pain or discomfort over the liver region.

For example, some people infected with hepatitis A virus, hepatitis B virus and hepatitis C virus have no symptoms, including many children younger than age 6 ¹. These people usually start to develop liver problem symptoms a few months after they come in contact with the virus ², ³. Furthermore, many people with cirrhosis of the liver or even liver cancer may also have no symptoms in the early stages of the disease or until the cancer is advanced.

You may also have other common symptoms of liver problems which are:

• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Fever
• Dark-yellow colored urine and pale bowel movements (light-colored stools)
• Stomach pain
• Jaundice, yellowing of the skin and whites of the eyes
• Fatigue
• Joint pain
• Skin rashes
• Bloating of the abdomen from ascites—a buildup of fluid in the abdomen
• Edema—swelling due to a buildup of fluid—in the feet, ankles, or legs
• Spiderlike blood vessels, called spider angiomas, on the skin

Therefore you cannot tell about the severity and type of liver problems or diseases simply by the symptom of liver pain or liver discomfort.

What is fatty liver symptoms pain ?

Fatty liver disease is a condition in which fat builds up in your liver ⁴. There are two main types:

1. Nonalcoholic fatty liver disease (NAFLD)
2. Alcoholic fatty liver disease, also called alcoholic steatohepatitis

What are the symptoms of fatty liver disease ?

Both nonalcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease are usually silent diseases with few or no symptoms ⁵, ⁶. If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.

What is nonalcoholic fatty liver disease (NAFLD) ?

Nonalcoholic fatty liver disease (NAFLD) is a type of fatty liver disease that is not related to heavy alcohol use. There are two kinds:

1. Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.
2. Nonalcoholic steatohepatitis (NASH), in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.

What is alcoholic fatty liver disease ?

Alcoholic fatty liver disease is due to heavy alcohol use. Most alcohol, after being absorbed in the digestive tract, is processed (metabolized) in the liver. As alcohol is processed, substances that can damage the liver are produced. The more alcohol a person drinks, the greater the damage to the liver. When alcohol damages the liver, the liver can continue to function for a while because the liver can sometimes recover from mild damage. Also, the liver can function normally even when about 80% of it is damaged. However, if people continue to drink alcohol, liver damage progresses and may eventually result in death. If people stop drinking, some damage may be reversed. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis of the liver.

For men, alcoholic fatty liver disease risk increases if they drink more than about 1 1/2 ounces of alcohol a day (especially if they drink more than about 3 ounces) for more than 10 years. Consuming 1 1/2 ounces a day involves drinking about 3 cans of beer, 3 glasses of wine, or 3 shots of hard liquor. For cirrhosis to develop, men usually must drink more than about 3 ounces a day for more than 10 years. Consuming 3 ounces a day involves drinking 6 cans of beer, 5 glasses of wine, or 6 shots of liquor. About half the men who drink more than 8 ounces a day for 20 years develop cirrhosis.

Generally, the more and the longer people drink, the greater their risk of alcoholic liver disease. However, liver disease does not develop in every person who drinks heavily for a long time.

Abuse of alcohol may cause three types of liver damage, which often develop in the following order:

• Accumulation of fat (fatty liver, or steatosis): This type is the least serious and can sometimes be reversed. It occurs in more than 90% of people who drink too much alcohol.
• Inflammation (alcoholic hepatitis): The liver becomes inflamed in about 10 to 35% of people.
• Cirrhosis of the liver: About 10 to 20% of people develop cirrhosis. In cirrhosis, a large amount of normal liver tissue is permanently replaced with scar tissue (called fibrosis), which performs no function. As a result, the internal structure of the liver is disrupted, and the liver can no longer function normally. Eventually, the liver usually shrinks. People may have a few symptoms or the same symptoms as those due to alcoholic hepatitis. Cirrhosis cannot be reversed.

Who gets fatty liver disease ?

Researchers do not know the cause of nonalcoholic fatty liver (NAFLD). They do know that it is more common in people who:

• Have type 2 diabetes and prediabetes
• Are obese
• Are middle aged or older (although children can also get it)
• Are Hispanic, followed by non-Hispanic whites. It is less common in African Americans.
• Have high levels of fats in the blood, such as cholesterol and triglycerides
• Have high blood pressure
• Take certain drugs, such as corticosteroids and some cancer drugs
• Have certain metabolic disorders, including metabolic syndrome
• Have rapid weight loss
• Have certain infections, such as hepatitis C
• Have been exposed to some toxins

Nonalcoholic fatty liver (NAFLD) affects about 25 percent of people in the world. As the rates of obesity, type 2 diabetes, and high cholesterol are rising in the United States, so is the rate of nonalcoholic fatty liver (NAFLD). NAFLD is the most common chronic liver disorder in the United States.

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time. The risk is higher for heavy drinkers who are women, are obese, or have certain genetic mutations.

How do you know if you have fatty liver disease ?

Because there are often no symptoms, it is not easy to find fatty liver disease. Your doctor may suspect that you have it if you get abnormal results on liver tests that you had for other reasons. To make a diagnosis, your doctor will use:

• Your medical history
• A physical exam
• Various tests, including blood and imaging tests, liver enzymes test and sometimes a liver biopsy

As part of the medical history, your doctor will ask about your alcohol use, to find out whether fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver (NAFLD). He or she will also ask which medicines you take, to try to determine whether a medicine is causing your NAFLD.

During the physical exam, your doctor will examine your body and check your weight and height. Your doctor will look for signs of fatty liver disease, such as:

• An enlarged liver
• Signs of cirrhosis, such as jaundice, a condition that causes your skin and whites of your eyes to turn yellow

You will likely have blood tests, including liver enzymes tests and blood count tests. In some cases you may also have imaging tests, like those that check for fat in the liver and the stiffness of your liver. Liver stiffness can mean fibrosis, which is scarring of the liver. In some cases you may also need a liver biopsy to confirm the diagnosis, and to check how bad the liver damage is.

What are the treatments for fatty liver disease ?

Doctors recommend weight loss for nonalcoholic fatty liver. Weight loss can reduce fat in the liver, inflammation, and fibrosis. If your doctor thinks that a certain medicine is the cause of your NAFLD, you should stop taking that medicine. But check with your doctor before stopping the medicine. You may need to get off the medicine gradually, and you might need to switch to another medicine instead.

There are no medicines that have been approved to treat NAFLD. Studies are investigating whether a certain diabetes medicine or Vitamin E can help, but more studies are needed.

The most important part of treating alcohol-related fatty liver disease is to stop drinking alcohol. If you need help doing that, you may want to see a therapist or participate in an alcohol recovery program. There are also medicines that can help, either by reducing your cravings or making you feel sick if you drink alcohol.

Both alcoholic fatty liver disease and one type of nonalcoholic fatty liver disease (nonalcoholic steatohepatitis) can lead to cirrhosis. Doctors can treat the health problems caused by cirrhosis with medicines, operations, and other medical procedures. If the cirrhosis leads to liver failure, you may need a liver transplant.

What are some lifestyle changes that can help with fatty liver disease ?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

• Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
• Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
• Get regular exercise, which can help you lose weight and reduce fat in the liver
• Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver.

1. Hepatitis A Questions and Answers for Health Professionals. Centers for Disease Control and Prevention, Division of Viral Hepatitis. https://www.cdc.gov/hepatitis/hav/havfaq.htm[↩]
2. Hepatitis B FAQs for health professionals. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm[↩]
3. Hepatitis C . The National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c[↩]
4. Fatty Liver Disease. Medline Plus. https://medlineplus.gov/fattyliverdisease.html[↩]
5. Symptoms & Causes of NAFLD & NASH. The National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes[↩]
6. Alcoholic Liver Disease. Merck Manual. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/alcoholic-liver-disease/alcoholic-liver-disease[↩]