Cirrhosis

Symptoms

People who have cirrhosis sometimes do not have symptoms until liver damage is extensive. Symptoms of cirrhosis and its complications may include:

• Fluid buildup in the legs (edema) and the abdomen (ascites).
• Fatigue.
• Yellowing of the skin (jaundice).
• Itching (pruritus).
• Profuse nosebleeds (epistaxis).
• Redness of the palms.
• Small red spots and tiny lines on the skin called spider angiomas.
• Bleeding from enlarged veins (varices) in the digestive tract.
• Bruising easily.
• Weight loss and muscle wasting.
• Abdominal pain or discomfort.
• Frequent infections.
• Confusion.

Complications of cirrhosis

Cirrhosis occurs when substantial amounts of scar tissue replace normal tissue in the liver. The scar tissue may block the proper flow of blood from the intestines through the liver, leading to increased pressure in the veins that supply this area (portal vein system). This condition is called portal hypertension. Portal hypertension can lead to other complications, which may include:

• Fluid buildup in the abdominal cavity (ascites). Ascites is the most common complication of portal hypertension caused by cirrhosis.
• Bleeding from enlarged veins (varices) in the digestive tract. This is called variceal bleeding. Variceal bleeding, especially in the esophagus and stomach, is a major cause of illness and death in people who have cirrhosis.
• Increased spleen size. This can lead to a low blood platelet count.
• Infection of the fluid in the abdomen (spontaneous bacterial peritonitis, or SBP). SBP develops in 10% to 25% of people who have advanced cirrhosis and ascites.¹
• Altered brain function (encephalopathy). Encephalopathy usually only occurs in people who have advanced portal hypertension. However, having a procedure to help reduce portal hypertension (shunting) can increase the risk of developing encephalopathy.
• Hepatorenal syndrome. Kidney (renal) failure can occur in cases of advanced liver disease stemming from cirrhosis. Usually, liver failure is the condition that threatens a person's life. However, in some cases, the liver disease may be stable, while kidney problems are life-threatening. A liver transplant may be necessary to cure renal failure caused by cirrhosis.¹
• Hepatopulmonary syndrome. Portal hypertension caused by cirrhosis can cause lung (pulmonary) problems, such as widening of the blood vessels in the lungs. This widening causes the blood to move too swiftly through the lungs to pick up enough oxygen. Liver transplantation is the most effective treatment for this condition.
• Hepatic hydrothorax. Cirrhosis can cause fluid to build up between the lungs and the chest (pleural effusion) and press on the lungs. Treatment can include taking medications such as diuretics, restricting salt in the diet, and using procedures to remove the fluid.

People who have cirrhosis may be at increased risk for developing gallstones.³ The more severe your liver disease, the higher your risk of developing gallstones.

People who have cirrhosis also are at increased risk of developing liver cancer, mainly hepatocellular carcinoma.

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Author:	Douglas Dana Shannon Erstad, MBA/MPH	Last Updated: May 30, 2006
Medical Review:	Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Steven L. Flamm, MD - Gastroenterology Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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