How COVID-19 Affects the Liver

COVID-19 affects all systems and organs. Although we often hear about the respiratory, immune, and cardiovascular systems, the gastrointestinal organs are affected just as much — especially the liver.

Dr. Anastasia

Infectious disease doctor

What happens?

COVID-19 enters the host cell through the interaction of its S-protein and human membrane protein (ACE2). This membrane protein is found in the epithelial cells lining the bile ducts. Penetration of S-protein leads to bile duct dysfunction. As a result, the liver cells undergo destruction, inflammation develops, and blood clots form in the liver vessels.

There is a direct correlation between the severity of the disease and liver damage. In the asymptomatic or mild form, the functional impairment of this organ is minimal, and recovery happens quickly. With a severe course of the disease, there is serious damage to the liver that requires a long recovery.


In addition to the damage caused by S-protein, the liver is also hit by its immune system. In response to the virus entering the body, immune cells produce cytokine proteins. If their levels become high, systemic inflammation develops, leading to reactive hepatitis.

Treat and cure

During the disease, you may have to take a large number of medications including antivirals, antibiotics, antipyretics, hormones, etc. Most of them have an extremely negative effect on the liver, which causes dysfunction.

How to understand if the liver is affected

The liver has no pain receptors that signal a problem, so a person will not immediately notice it. However, there are symptoms to look out for:

  • Jaundice of the skin and sclerae of the eyes, as well as a white plaque on the tongue
  • After the disease, the liver may enlarge, which is felt as a heaviness in the abdomen, pain in the right side, and a feeling of compression of the neighboring organs
  • When the outflow of bile is disturbed, nausea, bloating, an unpleasant and bitter taste in the mouth, stool disorders and increased gas formation occur
  • When the liver can no longer cleanse the body of harmful substances, they enter the blood, and there is a general weakness and itchy skin
  • Decreased appetite, weight loss, constant thirst, and changes in the color of the nails can be less obvious symptoms

If you have any of these symptoms, it is a good idea to consult with your doctor. Your doctor will likely run a series of tests including blood chemistry, ALT/AST levels, alkaline phosphatase, GGT, and a coagulogram since it is crucial to check blood clotting after coronavirus. The size and structure of the liver can be assessed by ultrasound and tomography. Under no circumstances should you try to diagnose and treat yourself! Only a medical specialist can diagnose you and develop a treatment plan

10 December 2021

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