Your liver, the largest internal organ in your body, is responsible for a lot. It removes toxins like alcohol from your bloodstream, regulates blood clotting, helps in bile production, and so much more. However, your liver can get damaged and have reduced functioning due to lifestyle habits or illness. In fact, liver disease is fairly common, affecting about 4.5 million adults in the U.S. Liver disease is a very broad term that includes many different conditions that impair normal liver function, according to gastroenterologist Dr. Douglas Weine. Liver conditions include hepatitis, non-alcoholic fatty liver disease, and even cancer.

Sometimes, these symptoms will occur immediately, but they will not always occur. According to hepatologist Dr. Bubu Banini, symptoms and signs of liver disease don’t typically present until there’s significant liver damage. So, how do you know when something is wrong with your liver, and how can you figure it out? Here are some common warning signs of liver disease and what to do if you see these issues.

Yellowing of the eyes or skin.

Dr. Banini said that a small sign of liver disease is the yellowing of the skin or the whites of your eyes, known as jaundice. This condition happens when there’s excess bilirubin, a pigment that’s created during the natural breakdown of red blood cless in the body. Bilirubin is usually processed by the liver and removed from the body, but not too much of it can cause jaundice and suggest liver issues. High levels of bilirubin aren’t always a huge issue for adults, but the underlying issues causing it can be, which is why it’s important to talk to your doctor if you recognize any yellowing of the eyes and skin.

Dark urine, even if you’re hydrated.

Dark urine on its own usually doesn’t concern people. Typically, it’s an indicator that you need to drink some extra fluids. However, it’s also typical for people with liver conditions to emit dark urine. This is due to the buildup of bilirubin, which can turn urine into a dark orange, amber, or brown color. If you’re drinking normally and still seeing issues with urine color, it could indicate that something else is going on.

Confusion.

Everyone forgets things from time to time, but significant changes to our mental state shouldn’t be ignored. They could be an indicator of liver issues or a number of other underlying problems. If you experience confusion or other mind-altering problems, it may be best to seek help right away. According to Dr. Banini, a person who’s otherwise healthy can develop acute liver failure that could manifest as changes in personality or mental state, such as confusion, sleepiness, or disorientation.

Swelling in the abdomen, ankles, or legs.

You might not associate this problem with liver issues, but swelling in your feet and legs could potentially indicate something is wrong. This is especially true when you’re experiencing cirrhosis or scarring of the liver. According to the Mayo Clinic, cirrhosis slows down the blood flow through the liver, increasing pressure in the vein that brings blood through the organ. The pressure in this vein, or the portal vein, can cause fluid to build up in the legs, called edema and in the abdomen, called ascites, noting that ascites and edema also may happen if the liver can’t make enough of certain blood proteins, like albumin.

Bleeding and bruising easily.

People with liver damage may bleed or bruise easily when injured, according to Dr. Weine. This happens because the liver creates proteins that the blood needs to clot, so when the liver isn’t functioning well, you’re easily prone to bleeding.

What to do if you think you have liver damage?

Liver problems aren’t something to dismiss. Moderate or heavy alcohol use, Type 2 diabetes, contact with toxins, using shared needles, or a family history of liver disease are all risk factors for liver damage. If you think you have any liver damage symptoms, it’s essential to talk about this with your provider. Other symptoms include exhaustion, stool changes, appetite changes and more. One professional suggested seeking immediate medical attention if you experience unexpected changes in the mental state, severe jaundice, the development of tarry or black stools, vomiting blood, swelling, or difficulty breathing. If you visit an emergency room, you can be referred to a liver specialist for further evaluation.