Symptoms of Cirrhosis
Patients with cirrhosis often have few symptoms at first. The
two major problems that eventually cause symptoms are loss of
functioning liver cells and distortion of the liver caused by
scarring. Patients may experience:
Fatigue.
Weakness.
Exhaustion.
Loss of appetite, often with nausea and weight loss.
Menstrual abnormalities (absent or infrequent periods
not related to menopause).
Impotence, loss of sexual drive or tender enlarged breasts
(for men).
As liver function declines, less protein is made by the organ.
For example, decreased production of albumin, a protein, can
result in water accumulating in the legs (edema) or abdomen
(ascites). A decrease in proteins needed for blood clotting makes
it easy for the person to bruise or bleed.
Late Stage or Advanced Cirrhosis
In the later stages of cirrhosis, jaundice (yellow skin) may occur,
caused by the buildup of bile pigment that is normally passed by the
liver into the intestines. Some people with cirrhosis experience
intense itching due to bile products that are deposited in the skin.
Gallstones often form in persons with cirrhosis because not enough
bile reaches the gallbladder. To learn more about gallstones, read the
AGA Institute brochure on that topic in your gastroenterologist’s
office or visit www.gastro.org/patient.
Patients with advanced cirrhosis have difficulty digesting certain
proteins that result in toxic levels of ammonia in the blood. This
condition is termed “hepatic encephalopathy” and can lead to
symptoms which range from mild sleep disturbances and difficulty
concentrating to unresponsiveness and coma. Many drugs are filtered
by the liver, but this process can be slowed down by cirrhosis. Because
the liver may not remove the drugs from the blood at the usual rate,
a drug may act longer than expected. This is especially true of
medications that may be sedating. People with cirrhosis are often very
sensitive to medications and their side effects.
A serious problem for people with cirrhosis is an increase in
pressure in the blood vessels that flow to the liver. Normally,
blood from the intestines and spleen is pumped to the liver
through the portal vein. But in cirrhosis, this normal flow of
blood is slowed, building pressure in the portal vein (portal
hypertension). This blocks the normal flow of blood, causing
the spleen to enlarge. The blood is frequently “shunted” around
the liver to return to the heart by smaller vessels, which may
become enlarged. In the stomach and esophagus these engorged
blood vessels are termed “varices” and are at increased risk of
bleeding, which is another major complication of cirrhosis.