When you schedule a colonoscopy, it’s usually to screen for colorectal cancer, investigate chronic digestive symptoms, or monitor an existing bowel condition. But what if you're also concerned about your liver health? Many people living with liver conditions wonder whether a colonoscopy can provide insight into the liver, especially since symptoms like abdominal pain, fatigue, or bloating can overlap.

In this article, we’ll explore what a colonoscopy can and can’t do when it comes to liver problems. You’ll learn how the procedure works, whether any signs of liver damage show up during the exam, and which tests truly assess your liver health.

What does a colonoscopy examine?

A colonoscopy is a procedure that allows your doctor to view the inside of your large intestine, also known as the colon, as well as the rectum. During the exam, a flexible tube with a tiny camera and light is gently inserted through your rectum and guided through the length of your colon. This helps your doctor look for:

• Polyps (which can develop into cancer)
  

• Inflammation or ulcers
  

• Sources of bleeding
  

• Signs of conditions like Crohn’s disease or ulcerative colitis
  

The goal is to inspect the mucosal lining of your colon—that is, the interior surface that can show early signs of disease.

Importantly, a colonoscopy does not visualize organs outside the colon, including your liver. The camera stays within the digestive tract, so anything located above the stomach—like the liver—is completely out of view.

If you want to better understand how liver-related symptoms are diagnosed, check out our guide on liver function tests and what they actually reveal.

Can a colonoscopy detect liver damage?

The short answer is no. A colonoscopy cannot directly detect liver damage.

That’s because the liver is not part of the gastrointestinal tract that a colonoscopy examines. The liver sits in the upper right portion of your abdomen, while a colonoscopy looks only at the lower digestive system. Even in people with liver disease, the colon itself might look entirely normal during the procedure.

However, there are a few indirect signs that might prompt your doctor to consider liver-related concerns. We’ll cover those next.

You can also explore what a liver ultrasound might detect if your doctor suspects an issue beyond the scope of a colonoscopy.

Why the liver isn’t visible during a colonoscopy

Anatomically, the liver is located under your right rib cage and above your intestines. It’s part of your upper gastrointestinal (GI) system and connected to your digestive tract via the bile ducts, which help digest fats.

Since a colonoscopy only visualizes the colon (large intestine) and rectum, it doesn’t come near the liver. No part of the scope enters the upper abdomen, and there is no way to see or assess liver tissue or structure during this exam.

To see the liver, your healthcare provider would need to order imaging tests that focus on the upper abdominal area. This includes tools like abdominal ultrasound, CT scans, MRI, or a specialized test like FibroScan.

In certain liver conditions like primary sclerosing cholangitis, colonoscopies may be recommended to monitor increased colon cancer risk.

Signs during a colonoscopy that may hint at liver problems

While a colonoscopy can't show your liver directly, it may reveal secondary effects of liver disease. These clues are usually linked to portal hypertension, a condition that occurs when there’s increased pressure in the portal vein (which carries blood from the intestines to the liver).

Here are a few signs that could appear during a colonoscopy and suggest liver issues:

1. Rectal or colonic varices

These are abnormally enlarged veins in the rectum or colon. They can occur due to portal hypertension, especially in people with advanced cirrhosis. They may not be common, but when present, they raise concern about liver function.

2. Hemorrhoids

Hemorrhoids are common in the general population, but if they appear especially swollen or engorged during a colonoscopy—particularly in someone with liver disease—they could be related to poor venous drainage from the liver.

3. Portal hypertensive colopathy

This refers to changes in the colon's mucosa (lining) that are associated with portal hypertension. Doctors may see a mosaic pattern, dilated vessels, or redness. While not specific to liver disease, these findings may lead your provider to investigate further.

A condition sometimes linked with hepatopulmonary syndrome, where liver and lung symptoms intersect due to blood vessel changes.

Tests that actually detect liver disease

To accurately assess liver health, your doctor will recommend other tools. These include:

Liver function tests (LFTs)

These blood tests evaluate how well your liver is working. They measure enzymes like ALT, AST, as well as bilirubin and albumin levels. Abnormal results may suggest inflammation, damage, or poor synthetic function. Liver function tests (LFTs): These include measurements of.

Imaging tests

• Ultrasound: Often the first test to check for fatty liver or liver enlargement.
  

• CT or MRI: Used to detect tumors, scarring, or anatomical changes.
  

• FibroScan: A non-invasive test that measures liver stiffness, which helps assess fibrosis or cirrhosis.
  

Liver biopsy

In some cases, a small tissue sample may be taken for analysis. This helps identify the extent of liver scarring, fat accumulation, or other structural damage.

These tests provide a clearer picture of liver function and health than anything seen during a colonoscopy.

Colonoscopy vs. liver diagnostic tools

Let’s compare what colonoscopy and liver tests actually look for:

When colonoscopy and liver evaluation overlap

There are certain situations where your doctor might recommend both a colonoscopy and liver tests. These may include:

• Monitoring people with primary sclerosing cholangitis (PSC), a liver disease that raises colon cancer risk.
  

• Pre-transplant evaluation, to ensure the colon is healthy before a liver transplant.
  

• Investigating symptoms like blood in stool, which might involve both GI and liver-related causes.
  

• Ruling out multiple conditions when someone has unexplained fatigue, weight loss, or abdominal swelling.
  
  

In these cases, colonoscopy serves a different purpose than liver assessment, but both provide valuable insights. This is especially important for people with a history of liver cancer or who are preparing for transplant evaluation.

Can liver disease affect your digestive system?

Yes. Liver disease can cause symptoms that affect digestion, either directly or indirectly:

• Nausea or loss of appetite: Common in people with hepatitis or cirrhosis.
  

• Bloating: Especially when ascites (fluid buildup) occurs.
  

• Changes in bowel habits: Including pale or greasy stools when bile flow is reduced.
  

• Upper GI bleeding: Due to esophageal or gastric varices.
  
  

These symptoms often warrant a combination of tests, including liver function tests, imaging, and endoscopic procedures like upper endoscopy or colonoscopy.

Should you get both a colonoscopy and a liver test?

If you’re over 45 (or younger with risk factors), a colonoscopy is often recommended for colon cancer screening. If you have symptoms like fatigue, jaundice, or abdominal swelling, your doctor may also order liver tests.

You don’t need to choose between them—both tests can be part of a broader health evaluation. In fact, it’s common for people with metabolic syndrome, diabetes, or obesity to undergo both procedures during a comprehensive checkup.

At Ribbon Checkup, we encourage a full picture approach: understand your colon health and your liver health, together.

Takeaway

If you’re relying on a colonoscopy to check everything below the surface, it’s a smart move—but it’s not the whole picture. While this test gives doctors a clear view of your colon, it won’t show how your liver is doing.

That’s why paying attention to fatigue, swelling, or unexpected digestive changes matters. These subtle signs might be pointing to something deeper—like liver inflammation, fatty liver, or even cirrhosis.

Curious about your liver health?

You don’t have to guess. Take the next step by exploring our at-home liver health test, or check out our library of trusted guides on Ribbon Checkup. Your liver works hard for you, make sure you’re looking out for it too.

Frequently asked questions

Can a colonoscopy detect fatty liver?

No. Fatty liver is a condition involving liver cells, which are not visible during colonoscopy. It requires blood tests or imaging to diagnose.

Do liver problems show up in colonoscopy images?

Not directly. While you may see indirect signs like varices or hemorrhoids, liver tissue itself is not part of what the colonoscope examines.

Is it safe to get a colonoscopy if I have liver disease?

In most cases, yes. However, people with advanced cirrhosis or blood clotting issues may need special preparation. Always inform your provider about your full medical history.

 

Written by Abel Tamirat, MD
Dr. Abel Tamirat is a licensed General Practitioner and ECFMG-certified international medical graduate with over three years of experience supporting U.S.-based telehealth and primary care practices. As a freelance medical writer and Virtual Clinical Support Specialist, he blends frontline clinical expertise with a passion for health technology and evidence-based content. He is also a contributor to Continuing Medical Education (CME) programs.

 

Related Resources

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• What Vitamins Support Liver Health?
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• Can Ultrasound Detect Liver Cancer?
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References

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Ratuapli, S. K., & Vargas, H. E. (2014). Colonoscopy in liver disease. Clinical Liver Disease, 4(5), 109–112. https://doi.org/10.1002/cld.433 

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