# 12 Signs of LIVER DISEASE You Can See: Doctor Explains

## Метаданные

- **Канал:** Violin MD
- **YouTube:** https://www.youtube.com/watch?v=q0j5b3oZCDk
- **Источник:** https://ekstraktznaniy.ru/video/41553

## Транскрипт

### Segment 1 (00:00 - 05:00) []

did you know that your skin nails even your breath could be revealing hidden clues about the health of your liver disease is far more common than most people realize I see it every single day in the hospital and often I can spot signs of liver disease the moment that I walk into a patient's room so today I'm going to show you the top 12 signs of liver disease so you know what to look out for take a look at your fingernails they are constantly growing through a complicated energy intensive process and as a result changes in your Health often show up in your nails and liver disease is no exception see these horizontal white lines running across the nail These Are W lines these lines are actually on the tissue underneath the nail not on the nail itself and if you apply pressure to The Nail they'll temporarily disappear of course since the lines are underneath the nail as your nail grows the line will stay in the same place it won't grow out here's another nail finding called Terry's nails look how strikingly pale the nails are normally your Nails have a pinkish color because of the tiny blood vessels that are in the tissue underneath your nail but in liver disease there are changes to that tissue which makes it difficult to see the tiny blood vessels and that's why the nails are so pale if you think that your nails look pale and you're wondering if you have Terry's Nails then check for the lunula which is this half moon at the base of the nail having a lunula is normal so if you can see it it's probably not Terry's nail so both of these nail findings Mo's lines and Terry's nails are both link linked to low levels of albumin is an important protein produced by the liver and it's often quite low in the setting of liver disease next I've got another test for you to try on yourself if you love this kind of information and want your questions answered in a monthly live stream then click the link up here to become a channel member put your nails together like this can you see a diamond-shaped gap between the bases of your nails if you can that's normal but if you can't and your nails look like this it's called clubbing and clubbing is caused by the proliferation of connective tissue between the nail and the finger bone which makes it thicker than normal while it can be genetic if I see clubbing of the nails I'm hunting for issues with the heart lungs or liver I want you to take a look at this woman's belly your first thought might be that she's pregnant but this is actually a very distended abdomen filled with fluid this is called aites shockingly the abdomen can stretch and fill with upwards of 15 L of fluid so where exactly does this fluid come from to understand this you need to know about the portal vein basically when you eat something your small bowel absorbs what it can into your bloodstream and all the blood from your digestive tract gets rooted through the liver to protect your body from any dangerous substances that may have been absorbed through your intestines the trouble is as liver disease progresses the liver becomes scarred and stiff and that scar tissue starts to block the blood vessels going through the liver making it harder for blood to flow through the portal vein think of it like pinching off a garden hose it leads to increased pressure Upstream in the portal vein which we call portal hypertension and because of all this extra pressure a huge amount of fluid can leak through the walls of the portal vein and into the abdominal cavity that's what causes aites to build up as you can imagine this can be really uncomfortable for someone and it can also make it difficult for them to breathe as the fluid pushes up on the diaphragm so I'll often do a procedure called a paracentesis this is where I put a large needle into the abdominal cavity and drain out that excess fluid here's a video of me in residency right after I completed a parentesis all those jugs are filled with liters of fluid that I drained out of a patient's abdomen and you can just imagine how much better that Patient felt but portal hypertension doesn't just cause fluid buildup in the abdomen it also forces blood to find a new route back to the heart since the portal vein is under high pressure blood is rerouted through small veins that aren't designed to handle this extra flow think of it like Google Maps rerouting you through narrow back alleys when there's a major traffic jam one place this happens is around the belly button where tiny veins in the abdominal wall expand and become visible Under the Skin this creates a really striking pattern of swollen twisting veins we call this capit Medusa named after the snake covered head of Medusa from Greek mythology and the same process can happen internally particularly in the esophagus where enlarged veins called veres can form these esophageal varices are fragile and they're prone to rupturing and bleeding and people with liver disease have difficulty forming blood clots to stop that bleeding this is what makes veral bleeds one of the most dangerous life-threatening complications of liver disease and if you ask anyone who works in the emergency department they'll have a terrifying story about this type of bleeding this is Palmer aemma notice how it affects the area over the thear and hypothenar eminences and Spares the center of the Palm this can be caused by

### Segment 2 (05:00 - 10:00) [5:00]

liver disease but it can also be seen in pregnancy so what do these two things have in common high estrogen levels the liver is responsible for breaking down estrogen and when it's not working properly estrogen builds up in the body one of the effects that estrogen has on the body is causing blood vessels to dilate or get wider high estrogen levels can also cause little blood vessels in the skin to dilate so they look like this sort of a spider-like shape which is how they got their name spider nevi a really cool thing about spider nevi is that if you apply pressure to the skin you can push the blood out of the vessels and they'll temporarily disappear now having one or two of these can be perfectly normal but if you have three or more spider nevi then your estrogen levels are probably on the high side and if you're not pregnant it would make me start to wonder about liver disease also leads to muscle wasting but this can sometimes be subtle and difficult to spot a good place to check is the palm of the hand because the muscles are small and close to the surface another good place where I check for muscle wasting is around the temples so why does this happen well the liver is responsible for processing nutrients making proteins and storing energy but when it's damaged the body starts breaking down muscle for fuel instead there's one more thing to look at in the Palm before we move on see the puckering of the skin in this picture and notice how this person's fingers are curled in and unable to fully extend this is called duperrin contracture it's a condition where the fascia in the Palm thickens and tightens over time which leads to Progressive finger contractures especially in the fourth and fifth digits there can be many causes including a strong genetic link it's actually quite common in people of northern European descent and it's how it got its nickname Viking disease so let's try a test together to check for duperrin contracture it's called the tabletop test and all you do is Lay Your Hand flat on a table and see if your palm can touch if it doesn't it could be because one or more of your fingers is too tight for from a contracture here's another really useful test that I use all the time in the hospital and it's easy to do yourself hold your arms out straight while extending your wrists and fingers for most of us that's probably pretty easy right but in liver disease patients can develop an involuntary flapping hand Tremor called asterixis here's an example of this in a middle-aged woman with Advanced liver disease and the reason behind this flapping movement demonstrates an interesting link between the liver and the Brain as you know the liver is responsible for clearing out toxins from our body and not just toxins that we ingest like alcohol but also toxins that come about from normal cellular function one of those toxins is ammonia which is produced from the breakdown of protein normally our liver can just clear that away but if the liver is damaged then ammonia levels build up and that affects the brain this is called hepatic encylopaedia and then when it remembers it starts Contracting the muscles again and that causes this flapping movement but hepatic and cyop can be far more serious than just a Tremor I remember one time I was assessing a patient who had come into the emergency department after his friend had found him unresponsive fortunately his vital signs were stable his blood sugar was normal and there were no other signs of critical illness so I did a really hard sternal rub to try to cause a little bit of pain and wake him up but still no response during the examination I couldn't help but notice a really distinct musty sweet smell on his breath I recognized that smell instantly it's called feeder hepaticus which is Latin for foul odor of the liver basically it's caused by toxins like dimethyl sulfide that build up in the blood and then get breathed out with carbon dioxide so I ordered stat blood work which showed a very high ammonia level and it turned out that this patient hadn't had a bowel movement in 3 days so what this patient became so constipated that he became unresponsive in a way yes you see bacteria in our intestines break down proteins and produce ammonia which then gets absorbed into our bloodstream unfortunately without regular bowel movements there was an overgrowth of ammonia producing bacteria in his colon and because this patient had liver disease he wasn't able to clear the ammonia from his body so it built up and poisoned his brain fortunately it's reversible and interestingly the treatment also has to do with the gut we give a specific laxative called lactulose which gets things moving and it also converts ammonia into ammonium which doesn't get absorbed into the bloodstream as easily it's amazing to see how a laxative can clear somebody's mind and even have them wake up from an unresponsive State now let's look at that video of asterixis one more time do you notice how her skin looks a little bit yellow this is called jaundice basically your liver is responsible for processing and eliminating Billy Rubin a yellow substance produced when red blood cells

### Segment 3 (10:00 - 12:00) [10:00]

break down but when the liver isn't working properly Billy Rubin can build up in the blood and if levels get high enough it can be quite dramatic even changing the color of your urine to a dark yellow or a brown tea color and this isn't the only cause of tea colored urine I made a whole video about what your urine says about your health so I'll leave a link in the description in case you want to watch that video next easy bruising or bleeding is also another concerning sign now I'm sure we've all noticed a bruise once in a while and thought where did that come from but if that's happening a lot or the bruises are really big and taking a long time to go away that could be a sign of liver disease now your body creates blood clots to stop bleeding and to make a blood clot you need clotting factors and platelets clotting factors are proteins created by the liver and in liver disease those levels decrease platelets on the other hand are tiny blood cells that Clump together to stop bleeding and they're produced by the bone marrow the liver comes into play because it makes a hormone called thrombo poetin which tells the bone marrow to make platelets and in liver disease there's less of that hormone so you end up with fewer platelets and to make matters worse the spleen is often enlarged in liver disease and that can sequester platelets and take them out of circulation unfortunately there's really no cure for liver disease aside from getting a liver transplant so prevention is key I can do a whole video dedicated to this topic but here it is in a nutshell the top preventable causes of liver disease include alcohol so minimize the amount that you're drinking metabolic syndrome which is linked to obesity and diabetes this is probably the most common cause of liver disease that I see in the hospital these days and the key to prevention is maintaining a healthy weight and then there's chronic viral hepatitis so that's Hepatitis B and C we have a vaccine against he B so I highly recommend you get that and about 10 years ago a cure for heepsy was developed which has been game-changing so hopefully that will no longer be a significant cause of liver disease disas in the future if you enjoy learning about signs of disease that you can see for yourself then check out this video next to find out what your hands say about your health stay curious stay healthy and I'll see you in the next video so bye for now