Signs and symptoms of cirrhosis
Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of the complications of cirrhosis. Many are nonspecific and may occur in other diseases and do not necessarily point to cirrhosis. Likewise, the absence of any does not rule out the possibility of cirrhosis.
* Spider angiomata or spider nevi. Vascular lesions consisting of a central arteriole surrounded by many smaller vessels due to an increase in estradiol. These occur in about 1/3 of cases.
* Palmar erythema. Exaggerations of normal speckled mottling of the palm, due to altered sex hormone metabolism.
* Nail changes.
o Muehrcke’s nails – paired horizontal bands separated by normal color due to hypoalbuminemia (inadequate production of albumin).
o Terry’s nails – proximal two thirds of the nail plate appears white with distal one-third red, also due to hypoalbuminemia
o Clubbing – angle between the nail plate and proximal nail fold > 180 degrees
* Hypertrophic osteoarthropathy. Chronic proliferative periostitis of the long bones that can cause considerable pain.
* Dupuytren’s contracture. Thickening and shortening of palmar fascia that leads to flexion deformities of the fingers. Thought to be due to fibroblastic proliferation and disorderly collagen deposition. It is relatively common (33% of patients).
* Gynecomastia. Benign proliferation of glandular tissue of male breasts presenting with a rubbery or firm mass extending concentrically from the nipples. This is due to increased estradiol and can occur in up to 66% of patients.
* Hypogonadism. Manifested as impotence, infertility, loss of sexual drive, and testicular atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function.
* Liver size. Can be enlarged, normal, or shrunken.
* Splenomegaly (increase in size of the spleen). Due to congestion of the red pulp as a result of portal hypertension.
* Ascites. Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs about 1500 mL to detect flank dullness). It may be associated with hydrocele and penile flomation (swelling of the penile shaft)[citation needed] in men.
* Caput medusa. In portal hypertension, the umbilical vein may open. Blood from the portal venous system may be shunted through the periumbilical veins into the umbilical vein and ultimately to the abdominal wall veins, manifesting as caput medusa.
* Cruveilhier-Baumgarten murmur. Venous hum heard in epigastric region (on examination by stethoscope) due to collateral connections between portal system and the remnant of the umbilical vein in portal hypertension.
* Fetor hepaticus. Musty odor in breath due to increased dimethyl sulfide.
* Jaundice. Yellow discoloring of the skin, eye, and mucus membranes due to increased bilirubin (at least 2–3 mg/dL or 30 mmol/L). Urine may also appear dark.
* Asterixis. Bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in patients with hepatic encephalopathy.
* Other. Weakness, fatigue, anorexia, weight loss.
Complications
As the disease progresses, complications may develop. In some people, these may be the first signs of the disease.
* Bruising and bleeding due to decreased production of coagulation factors.
* Jaundice due to decreased processing of bilirubin.
* Itching (pruritus) due to bile salts products deposited in the skin.
* Hepatic encephalopathy – the liver does not clear ammonia and related nitrogenous substances from the blood, which are carried to the brain, affecting cerebral functioning: neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.
* Sensitivity to medication due to decreased metabolism of the active compounds.
* Hepatocellular carcinoma is primary liver cancer, a frequent complication of cirrhosis. It has a high mortality rate.
* Portal hypertension – blood normally carried from the intestines and spleen through the hepatic portal vein flows more slowly and the pressure increases; this leads to the following complications:
o Ascites – fluid leaks through the vasculature into the abdominal cavity.
o Esophageal varices – collateral portal blood flow through vessels in the stomach and esophagus. These blood vessels may become enlarged and are more likely to burst.
* Problems in other organs.
o Cirrhosis can cause immune system dysfunction, leading to infection. Signs and symptoms of infection may be aspecific are more difficult to recognize (e.g. worsening encephalopathy but no fever).
o Fluid in the abdomen (ascites) may become infected with bacteria normally present in the intestines (spontaneous bacterial peritonitis).
o Hepatorenal syndrome – insufficient blood supply to the kidneys, causing acute renal failure. This complication has a very high mortality (over 50%).
o Hepatopulmonary syndrome – blood bypassing the normal lung circulation (shunting), leading to cyanosis and dyspnea (shortness of breath), characteristically worse on sitting up.
o Portopulmonary hypertension – increased blood pressure over the lungs as a consequence of portal hypertension.