What to know about liver pain: Possible causes and management

Possible causes of liver pain

Liver pain can be a sign of liver disease, which refers to any condition that causes liver inflammation or damage. Without treatment, the liver may eventually stop functioning.

Symptoms of liver disease often do not appear until more advanced stages, so it is important to be aware of liver pain and other symptoms that could signal a liver disorder.

Many different types of liver disease can cause liver pain. The following are a few examples.

Cholangitis

Cholangitis is inflammation of the bile duct system, usually due to a bacterial infection. The bile duct drains bile from the liver and gallbladder, carrying it to the small intestine.

Cholangitis can develop from an obstruction or blockage in the bile duct system, causing bile to back up. This may be due to gallstones, a tumor, or another cause which allows backflow of bacteria.

Hepatitis

Hepatitis is inflammation of the liver. The most common cause is a virus, but other causes include:

• excess alcohol use
• toxins
• some medications
• certain medical conditions

There are five main types of hepatitis virus:

• Hepatitis A is detectable in the feces of a person with the virus, which can then be transmitted via contaminated water or food.
• Hepatitis B transmits through exposure to body fluids, such as blood and semen.
• Hepatitis C transmits through infected blood or sometimes sexual transmission.
• Hepatitis D is a secondary infection that only affects those who have hepatitis B.
• Hepatitis E transmits through the consumption of contaminated water or food.

The most common types of viral hepatitis in the United States are:

• hepatitis A
• hepatitis B
• hepatitis C

Hepatitis can be acute, meaning sudden and short term, or chronic, meaning long-term and persistent.

Hepatitis B, C, and D cause chronic hepatitis, which can eventually lead to cirrhosis, liver failure, or liver cancer.

Liver abscess

A liver abscess is a pocket of infected fluid, or pus, that forms in the liver. An injury or infection from certain germs, such as bacteria, parasites, or fungi, can cause it.

An abscess can damage nearby tissue and can lead to bleeding, additional infections, and even death. Treatment may include an antibiotic or antifungal medication, and doctors may drain the abscess.

Follow-up imaging tests of the liver are usually conducted to ensure that the abscess is gone and that there is no permanent damage.

Cirrhosis

Cirrhosis is an irreversible scarring of the liver. The liver slowly worsens and becomes unable to work properly due to long-lasting injury.

Over time, scar tissue replaces healthy liver tissue, which can begin to block blood flow through the liver. A healthy liver can regenerate its damaged cells. If the damage is too severe or long lasting, the liver cannot completely repair itself and creates scar tissue instead.

Cirrhosis happens gradually, but, as it worsens, the liver will begin to fail. This can lead to chronic liver failure or end stage liver disease, where the liver can no longer perform vital functions.

Budd-Chiari syndrome

Budd-Chiari syndrome is a rare liver disease in which blood flow out of the liver via the portal vein is blocked. This can be due to a problem within the vein, such as a blood clot or swelling of the vessel walls narrowing the vein. It can also be due to compression of the vein from a process outside the vein itself.

Blood backs up in the liver, causing it to enlarge. In some cases, the spleen may also enlarge.

The buildup of blood causes an increase in blood pressure in the portal vein. This is the vein responsible for carrying blood to the liver from the intestines. This increase in pressure is known as portal hypertension.

Portal hypertension causes fluid to build up in the abdomen. The blocked veins cause the blood flow from the liver to the heart to slow down or stop. Scarring of the liver or cirrhosis is also possible.

The effects of alcohol

Excess alcohol consumption may lead to liver diseases such as hepatitis, cirrhosis, or steatosis (fatty liver).

The liver usually breaks down alcohol and removes it from the body. If a person consumes more alcohol than the liver can process, liver cells may be damaged or destroyed.

Liver disease due to alcohol can be reversible in milder cases. However, a consistently high alcohol intake over time can lead to a buildup of fat and inflammation in the liver, which can result in alcohol-related cirrhosis.

Cirrhosis due to alcohol is not reversible, but cutting out alcohol can help prevent further damage and may help improve symptoms.

Signs of liver damage

Many people may not notice signs or symptoms of liver damage until it is in its more advanced stages.

Early signs of liver damage may include:

• tiredness
• weakness
• loss of appetite
• nausea
• vomiting
• weight loss
• skin itching

Symptoms of advanced liver disease may include the above, as well as:

• swelling in the legs and abdomen
• bruising and bleeding more easily
• jaundice
• dark urine
• internal bleeding
• cognitive impairment

When to contact a doctor about liver pain

Many conditions can cause liver pain, so it is important for people to contact a doctor to determine the underlying cause.

A doctor will likely begin by carrying out a physical examination and looking at the person’s health history.

They may then order tests such as:

• blood tests to assess liver function or identify specific liver problems or genetic conditions
• imaging tests, such as CT scans, MRIs, and ultrasounds to assess for liver damage
• tissue analysis, which involves taking a tissue sample from the liver for a lab test

Sometimes, liver pain will go away after making some lifestyle changes, such as abstaining from alcohol or making dietary changes.

Other problems may require medication or surgery. For example, liver failure may require a liver transplant.

When to seek emergency care

A person should seek immediate medical treatment if they experience any of the following symptoms:

• severe pain, especially in the abdomen
• fever
• dark urine
• pale, bloody, or tar-colored stools
• nausea and vomiting
• weight loss
• yellowish skin
• severe tenderness when touching the abdomen
• swelling in the abdomen or in the legs and ankles
• itchy skin
• chronic fatigue
• loss of appetite

Preventing or managing liver pain

To help prevent or manage liver pain, steps that may help include:

• following a balanced diet
• staying hydrated
• limiting or avoiding alcohol consumption
• avoiding activities that may cause harm, such as sharing drug needles
• avoiding having sex without using a barrier method
• getting vaccinated against hepatitis, if appropriate
• getting screened for hepatitis, if appropriate
• using medications only as directed
• maintaining a moderate weight

Summary

Liver pain can range from dull and achy to more severe pain in the upper right abdomen, the upper right shoulder, or the middle of the back. This type of pain can be a sign of underlying liver disease.

Possible causes include cholangitis, hepatitis, liver abscess, cirrhosis, Budd-Chiari syndrome, and excess alcohol consumption.

Working with a healthcare professional to determine the underlying cause and following a suitable treatment plan can help manage pain, while also minimizing the risk of disease progression in some cases.