Doctors diagnosing liver disease often spot symptoms in the nails

Liver disease: NHS Doctor talks about link with alcohol

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Many people have the early stages of liver disease and only a small portion go on to develop serious complications. Unfortunately, diagnosing the disease is no easy task because symptoms rarely appear before the final stages. At this step of the disease, nail abnormalities are frequently encountered by doctors.

In fact, dermatologic manifestations often provide some of the first clues of underlying liver disease.

The causes of nail changes associated with cirrhosis, however, remain unknown.

Research from the Department of Dermatology at Sohag University suggests the changes may be a consequence of decreased immunity, iron deficiency, anaemia or old age.

The health body states: “It is important for the clinicians to understand and examine carefully the nails for colour, texture, thickness and curvature to reach a prompt and early diagnosis of patients with liver disease.”

To understand the prevalence of nail changes, the health body launched a study to examine different cutaneous manifestations associated with liver disease.

The medical department noted: “Finger clubbing is a well-recognised sign of chronic liver disease, especially primary biliary cirrhosis and chronic active hepatitis.

“Terry’s nails, in which the proximal two-thirds of the nail plate turns powder white with a ground-glass opacity, may develop in patients with advanced cirrhosis.”

According to Mount Sinai explains, clubbed fingers are a symptom of disease, often of the heart or lungs, which cause chronically low blood levels of oxygen.

It’s been suggested in early research that clubbing in cirrhosis is not a result of bone disorders but rather caused by an increase in peripheral blood flow with dilation of the veins in the finger.

In the beginning, nail clubbing is caused by softening of the nail bed, followed by an increase in the normal 160-degree angle between the nail bed and the proximal nail fold.

“Eventually the nail and periungual skin appears shiny and the nail develops longitudinal ridging,” explains the Saudi Medical Journal.

In the study, a total of 80.5 percent of patients with liver disease showed nail changes, marking a higher prevalence than that found in earlier research.

In an Egyptian study dating back to 2010, for instance, researchers recorded nail changes in as many as 68 percent of patients with liver disease.

In 2013, a study published in the Journal of Evolution of Medical and Dental Sciences reported nail changes in 72 percent of the sample studied.

Moreover, a 2018 study published in the International Journal of Research in Dermatology, found nail changes in 60 percent of patients with chronic liver diseases.

How long does it take for cirrhosis symptoms to appear?

It has generally been thought that the progression from early-stage non-alcoholic fatty liver disease takes decades.

Recent studies, however, have found that some cases progress rapidly, within the short space of two years.

In no particular order, symptoms of cirrhosis tend to include:

• Fatigue
• Weakness
• Weight loss
• Nausea
• Bruising
• Redness on the palms
• Spider-like blood vessels on the skin.

Some people are more susceptive to liver cell damage than others, so symptoms of cirrhosis can develop at different rates for different people

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