In some cases, cirrhosis may produce no symptoms until complications develop.
The portal vein carries blood from the stomach, intestines, spleen, gallbladder, and pancreas to the liver. In cirrhosis, bands of scar tissue partially block the normal flow of blood, which increases the pressure in the portal vein. This condition is called portal hypertension, and it is a common complication of cirrhosis. Portal hypertension can lead to other complications, including:
- Edema: Edema is swelling due a buildup of fluid in the feet, ankles, or legs.
- Ascites: Ascites is a buildup of fluid in the abdominal cavity, or belly. Mild ascites may only be detectable with imaging tests, but as the amount of ascites increases, symptoms can include bloating of the abdomen, decreased appetite, and abdominal discomfort. It can also lead to shortness of breath when the fluid buildup restricts the normal expansion of the chest. If ascites fluid becomes infected, it causes a serious condition called spontaneous bacterial peritonitis, which often requires hospitalization.
- Varices in the digestive tract: Varices are enlarged blood vessels. Portal hypertension can cause varices in the esophagus, stomach, or both. Variceal transformation causes vessel walls to become thin and blood pressure to increase, making the blood vessels more likely to burst. If they burst, serious bleeding can occur in the esophagus or upper stomach, which requires immediate medical attention.
- Splenomegaly: Splenomegaly is a term describing an enlarged spleen. Portal hypertension can cause the spleen to enlarge and retain white blood cells and platelets, reducing the number of these cells and platelets in the blood. White blood cells help the body fight infection.
When the liver fails to remove toxins from the blood, those toxins eventually accumulate in the brain. This buildup of toxins in the brain leads to a clinical condition called hepatic encephalopathy. This condition can decrease mental function and cause stupor and even coma. Stupor is an unconscious, sleep-like state from which a person can only be aroused briefly by a strong stimulus, such as a sharp pain. Coma is an unconscious state from which a person cannot be aroused. Signs of decreased mental function include:
- Personality changes
- Memory loss
- Trouble concentrating
- A change in sleep habits
Metabolic Bone Diseases
A metabolic bone disease is a disorder of bone strength usually caused by abnormalities of vitamin D, bone mass, bone structure, or minerals, such as calcium and phosphorous. When liver disease affects the bile ducts, cirrhosis can cause metabolic bone diseases, such as osteopenia and osteoporosis.
Gallstones and Biliary Stones
Bile is a digestive enzyme that is manufactured in the liver and delivered, through a system of various-sized ducts, to the gallbladder for storage, and to the small intestine to aid in digestion. If scar tissue prevents bile from flowing freely in these ducts and in the gallbladder, biliary sludge and even gallstones can form. Symptoms of gallstones include abdominal pain and recurrent bacterial infection of the bile ducts, called cholangitis.
Bruising and Bleeding
When chronic liver failure leads to inadequate production of the proteins needed for blood clotting, a person will bruise or bleed easily, and it may be difficult to stop bleeding.*
Sensitivity to Medications
Cirrhosis affects the liver's ability to chemically process and remove medications and medication breakdown products from the bloodstream. This can cause medications to act longer than expected and accumulate in the body.
Primary liver cancer, or cancer that starts in the liver rather than spreading to the liver from somewhere else, is more common in people with cirrhosis. Liver cancer has a low survival rate. People with cirrhosis may be checked for signs of liver cancer every six to 12 months.
Cirrhosis is linked to several other conditions, including:
*Because the liver is also responsible for making anti-clotting factors, cirrhosis can also increase the risk of developing blood clots, particularly in the abdominal veins.
- Insulin resistance, which can lead to the development of type 2 diabetes
- Immune system dysfunction, which can lead to increased susceptibility to infection
- Kidney failure, which is known as hepatorenal syndrome when caused by cirrhosis
- Lung failure, which is known as hepatopulmonary syndrome when caused by cirrhosis