History and physical examination often suggest a cause of potential liver disorders and narrow the scope of testing for hepatic and biliary disorders.
History
Various symptoms may develop, but few are specific for liver disorders:
Common nonspecific symptoms include fatigue, anorexia, nausea, and occasionally, vomiting, particularly in severe disorders.
Loose, fatty stools (steatorrhea) can occur when cholestasis prevents sufficient bile from reaching the intestines. Patients with steatorrhea are at risk of deficiencies of fat-soluble vitamins (A, D, E, K). Common clinical consequences may include osteoporosis and bleeding.
Fever can develop in viral or alcoholic hepatitis.
Jaundice, occurring in both hepatocellular dysfunction and cholestatic disorders, is the most specific symptom. It is often accompanied by dark urine and light-colored stools.
Right upper quadrant pain due to liver disorders usually results from distention (eg, by passive venous congestion or tumor) or inflammation of the liver capsule.
Erectile dysfunction and feminization develop, usually due to imbalances in the normal estrogen/testosterone ratio, with more estrogen being present than is typical.
(See also Liver Structure and Function.)
Family history, social history, and drug and substance use history should note risk factors for liver disorders (see table Risk Factors for Liver Disorders ).
Physical examination
Abnormalities detectable during a physical examination usually do not develop until late in the course of liver disease. Some common findings suggest a cause (see table Interpretation of Some Physical Findings ).
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Testing
Testing for hepatic and biliary disorders, including blood tests, imaging, and sometimes liver biopsy, plays a prominent role in the diagnosis of liver disorders. Individual tests, particularly those of liver biochemistry and excretion, often have limited sensitivity and specificity. A combination of tests often best defines the cause and severity of disease.
