Warning signs that your liver may be struggling include ongoing fatigue, yellowing of the skin or eyes (jaundice), dark urine, pale or clay colored stools, itchy skin, easy bruising, and swelling in the belly or legs. These signs often trace back to common conditions like fatty liver disease, alcohol use, viral hepatitis, or certain medications. Less often, they point to advanced liver damage that needs prompt medical evaluation.

1. Nonalcoholic Fatty Liver Disease

What it is: A buildup of fat in the liver not caused by heavy alcohol use, now also called metabolic dysfunction associated steatotic liver disease.

Why it happens: Excess weight, insulin resistance, high blood sugar, and high triglycerides encourage fat to accumulate in liver cells over time.

Common symptoms: Often none at all in early stages. As it progresses, it can cause mild fatigue, a dull ache in the upper right abdomen, and mildly elevated liver enzymes found on routine blood work.

Risk factors: Obesity, type 2 diabetes, high cholesterol, high blood pressure, and metabolic syndrome.

When to seek evaluation: If routine bloodwork shows elevated liver enzymes, or you have these risk factors along with unexplained fatigue, ask your doctor about liver imaging and further testing.

2. Alcohol-Related Liver Disease

What it is: Liver damage caused by drinking alcohol over time, ranging from fatty buildup to inflammation to permanent scarring.

Why it happens: The liver breaks down alcohol, and heavy or long-term drinking produces byproducts that injure liver cells and trigger inflammation and scarring.

Common symptoms: Fatigue, loss of appetite, nausea, and tenderness in the upper right abdomen, with jaundice or belly swelling appearing in later stages.

Risk factors: Heavy or long-term alcohol use, binge drinking, obesity, and hepatitis C infection.

When to seek evaluation: Anyone who drinks heavily and notices fatigue, appetite loss, or abdominal discomfort should talk to a doctor about liver testing and support for cutting back.

3. Viral Hepatitis (Hepatitis B and C)

What it is: Inflammation of the liver caused by a viral infection, which can be short-term (acute) or long-term (chronic).

Why it happens: Hepatitis B and C viruses spread through contact with infected blood, and hepatitis B can also spread through other body fluids, quietly inflaming the liver for years.

Common symptoms: Many people have no symptoms for years. When present, symptoms include fatigue, low-grade fever, nausea, dark urine, and jaundice.

Risk factors: Past injection drug use, blood transfusions before widespread screening, unprotected sex with an infected partner, and being born to a mother with hepatitis B or C.

When to seek evaluation: Anyone with these risk factors, even without symptoms, should ask about hepatitis B and C screening, since early treatment can prevent serious liver damage.

4. Medication or Supplement-Related Liver Injury

What it is: Liver damage caused by a medication, herbal product, or supplement, sometimes called drug-induced liver injury.

Why it happens: The liver processes most medications and supplements, and some, taken in high doses or combined with other substances, can injure liver cells directly or trigger an immune reaction.

Common symptoms: Fatigue, nausea, loss of appetite, dark urine, and jaundice, usually appearing days to weeks after starting or overusing a product.

Risk factors: Taking more than the labeled dose of acetaminophen, combining acetaminophen with alcohol, using certain herbal supplements, and taking multiple medications that affect the liver.

When to seek evaluation: Stop the suspected product and contact a doctor promptly if jaundice, dark urine, or persistent nausea develop after starting any new medication or supplement.

5. Gallstones and Bile Duct Blockage

What it is: Hardened deposits in the gallbladder that can block the bile duct and cause bile to back up toward the liver.

Why it happens: A blocked bile duct prevents bile from draining normally, which can lead to inflammation and pressure buildup affecting the liver.

Common symptoms: Sudden pain in the upper right abdomen, especially after fatty meals, along with nausea, and, if the duct is blocked, jaundice, dark urine, and pale stools.

Risk factors: Being female, obesity, rapid weight loss, pregnancy, and a family history of gallstones.

When to seek evaluation: See a doctor promptly for repeated abdominal pain after meals, and seek same-day care if pain is severe or comes with jaundice or fever.

6. Autoimmune Hepatitis

What it is: A condition in which the immune system mistakenly attacks liver cells, causing ongoing inflammation.

Why it happens: The exact trigger is not fully understood, but the immune system treats liver tissue as a threat, leading to chronic inflammation and, over time, scarring.

Common symptoms: Fatigue, joint pain, itchy skin, jaundice, and an enlarged liver, though some people have no symptoms early on.

Risk factors: Being female, having another autoimmune condition, and a family history of autoimmune disease.

When to seek evaluation: Persistent fatigue and joint pain along with abnormal liver blood tests should be evaluated by a doctor, since early treatment can slow the disease.

7. Hemochromatosis (Iron Overload)

What it is: A condition in which the body absorbs and stores too much iron, which can build up in the liver and other organs.

Why it happens: Most cases are inherited, caused by a gene that increases how much iron the intestines absorb from food over a lifetime.

Common symptoms: Fatigue, joint pain, and abdominal discomfort in earlier stages, with skin darkening and signs of liver damage if iron builds up for years untreated.

Risk factors: A family history of hemochromatosis, being male, and having northern European ancestry.

When to seek evaluation: Anyone with a family history of hemochromatosis, or unexplained fatigue and joint pain, should ask a doctor about iron level testing.

8. Cirrhosis With Decompensation

What it is: Advanced scarring of the liver that has progressed to the point the liver can no longer function normally.

Why it happens: Years of ongoing liver injury, from causes such as fatty liver disease, alcohol use, or chronic hepatitis, gradually replace healthy liver tissue with scar tissue.

Common symptoms: Persistent jaundice, swelling in the abdomen or legs, easy bruising or bleeding, confusion or trouble concentrating, and marked fatigue.

Risk factors: Long-standing fatty liver disease, chronic alcohol use, chronic viral hepatitis, and untreated autoimmune or genetic liver conditions.

When to seek evaluation: Anyone with known liver disease who develops new confusion, worsening swelling, or bleeding needs prompt medical evaluation, since this can progress to a medical emergency.

9. Acute Liver Failure

What it is: A rare, rapid loss of liver function that can develop over days to weeks, often in someone with no prior liver disease.

Why it happens: Common causes include a large acetaminophen overdose, a severe reaction to a medication, certain viral infections, or, rarely, poisoning from toxic mushrooms.

Common symptoms: Rapid onset of jaundice, confusion or an altered mental state, easy bruising or bleeding, and marked drowsiness.

Risk factors: Acetaminophen overdose (intentional or accidental), severe viral hepatitis, and serious reactions to certain medications.

When to seek evaluation: This is a medical emergency. Call 911 or go to the emergency room immediately, especially if confusion or drowsiness is present.

When to Seek Medical Care