Liver problems are sometimes the first thing that comes to our minds when talking about the side effects of excessive alcohol intake, and cirrhosis is one of the most feared outcomes. The liver is the organ in the body that is in charge of cleaning the blood from metabolic waste. It is also capable of getting rid of toxins, which is why it works alongside with the kidneys in constantly filtrating the blood.
Liver cirrhosis is the end-stage of inflammation and fatty liver disease, and it may appear in people with liver problems, whether or not they drink alcohol. Other precipitating factors are chronic hepatitis and non-alcoholic fatty liver disease. If you have the suspicion that your liver is not working as it should, take a look at these symptoms of liver cirrhosis and do not delay your diagnosis.
Jaundice
The most common symptom in liver disease is jaundice, a yellowish coloration of the skin and mucosal membranes. It happens because the bilirubin, which is a byproduct of human metabolism, is not adequately cleared out of the blood, and it slowly accumulates. Bilirubin is a strong pigment, and it builds up in the skin, changing its color.
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People with jaundice have a yellow color, not only in their skin but in their eyes as well. This is an excellent way to differentiate jaundice from changes in skin tone people experience after eating foods with high levels of carotenoids.
Skin itching
Jaundice is often associated with itchy skin because, as it builds up, bilirubin stimulates nerve terminals and creates this sensation throughout the body. It is not only bilirubin, but other toxins may start to accumulate and create irritation to the nerve terminals. Sometimes, pruritus in liver cirrhosis tends to be more severe in hands and feet, and it is often difficult to control, even after starting therapy.
Slow healing
The liver is in charge of creating blood clotting proteins essential to the normal healing process. There are plenty of clotting factors contributing to the healing process, and some of them are not synthesized in the liver, which is why there’s still a clotting process, but very weak and slow.
Thus, patients with liver cirrhosis are prone to bleeding and maintaining sores and ulcers for a long time. Bleeding gums, slow-healing sores, and easy bruising are common in these patients, and it might turn into a complication if the patient is diabetic or has another underlying disease.
Blood in the stools
Since liver cirrhosis patients have a slow healing process, those who suffer from gastrointestinal problems such as duodenal or stomach ulcers would have a worse prognosis. They would have sustained gastrointestinal bleeding, which in most cases appear in the stools.
Blood in the stools can be either macroscopic, or clearly visible, or microscopic, which is only traceable under a microscope. Macroscopic blood often changes the color of the stools to a darker black, and it has a strong smell that results from the decay of blood when it comes into contact with the gut microbiota.
Dark urine
This symptom is common in liver cirrhosis and should be examined alongside with jaundice because it is caused by the same mechanism of disease. We have mentioned how bilirubin builds up in the blood instead of passing through the cleansing filters in the liver. When it accumulates in the blood, the kidneys take the place of the liver in clearing the blood, and bilirubin is eliminated through the urine. This is a strong pigment and may change the color of the urine to a dark tone that may strike patients as blood, similar to cola beverages.
Swollen abdomen
The liver produces many different proteins, and one of them is called albumin, and it is the most abundant protein in the blood. Albumin creates something called osmotic pressure, which is a dynamic chemical interaction between solute and solvent that maintains body fluids in place.
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When the liver is affected by liver cirrhosis, protein production slows down and the circulating levels of albumin drops. As it does, the liquid starts to escape the blood to the interstitial tissue and swelling appears throughout the body. In severe cases, patients develop a swollen and rounded abdomen as free liquid accumulates in the abdominal cavity.
Chronic fatigue
The liver is important for the metabolism of carbohydrates and energy, and it is also an important step to clear out the blood from toxins. When there’s an abnormal function in the liver, the production of energy would also suffer, and patients often feel lightheaded with muscle weakness and tired. As the disease progresses, general malaise becomes chronic fatigue and patients struggle to perform their daily chores and even apparently simple tasks make them feel exhausted.
Fatigue problems become worse in the late-stage of the disease when patients start having neurological manifestations of liver cirrhosis. In these cases, there’s a severe liquid imbalance affecting the brain and may add up to the chronic fatigue.
Loss of appetite
Patients with liver cirrhosis enter into a stage of general malaise that is also accompanied by loss of appetite and intestinal absorption problems. Altogether, these symptoms speed up the progression of the disease as the patient becomes malnourished. Loss of appetite is often associated with nausea, which is also common in liver disease, and when cirrhosis is induced by alcohol, there’s an even higher probability of suffering from loss of appetite.
In some cases, the abdominal swelling pushes aside the stomach, making patients feel satiated before it is properly filled with food. There’s an impaired capacity of the stomach to accommodate, and abdominal discomfort makes patients avoid what they feel as excess food.
Bloating
Most gastrointestinal problems in liver cirrhosis are associated with an impaired motility of the intestines. Patients feel abdominal pain and bloating, often nausea as well, and they develop acid reflux and similar problems. In advanced stages of cirrhosis, these symptoms are severe enough to cause an impairment in the quality of life and severe appetite changes.
Weight changes
Liver cirrhosis is also linked to nutrient malabsorption because there is something called portal hypertension. Portal circulation is an internal blood circulation between the gut and the liver, and when the liver is affected by cirrhosis it becomes resistant to the blood flow, and the resulting pressure works against the flow of blood and impairs the normal absorption of nutrients.
Additionally, patients feel gastrointestinal symptoms, and liver cirrhosis along with alcohol intake induces anorexia, which is the clinical name of appetite loss. Altogether, these changes promote weight loss and malnutrition as one of the most common outcomes of liver cirrhosis.
However, in some cases, patients gain weight instead because there’s massive fluid retention, especially in the abdominal cavity, and they might be increasing their water weight dramatically.
Difficulty breathing
In a late stage of the disease, patients start having breathing difficulty as a series of pulmonary complications ensue. Most of them have to do with fluid retention and fluid balance. First off, there’s hepatic hydrothorax, a common complication that arises when there’s an accumulation of fluid in the pleural space. It accumulates in this area as a result of portal hypertension.
There’s also a change in blood pressure in the pulmonary arteries, which is known as pulmonary hypertension. In these patients, portal hypertension represents an obstruction to the normal flow, and the heart slowly becomes unable to handle the extra pressure. In the end, the excess pressure would drain to the pulmonary circulation.
All of these changes make it difficult to breathe, and the underlying problem is detected through a computed tomography, radiograph, and even ultrasound imaging. These changes typically occur in late-stage disease, and they require urgent medical attention.
Confusion and other neurological symptoms
In liver cirrhosis and late-stage hepatic failure, there’s a syndrome called hepatic encephalopathy. It is the most serious complication of cirrhosis, and it affects the normal function of the brain, sometimes leading to brain edema and progressive worsening of the symptoms to a life-threatening degree.
The fluid alterations in the brain progress quickly, and patients may start with a mild cognitive decline that slowly turns into confusion, disorientation, seizures, and other alterations of the consciousness.
In some cases, patients have neurological symptoms for many years, and they remain clinically undetectable, but in most cases, neurological symptoms signal the start of the end-stage liver disease.
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- Liver Disease: Top Warning Signs and Symptoms, Causes, Diagnosis, Treatment, and How To Keep a Healthy Liver?
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As you can see, liver cirrhosis is a severe problem that requires urgent medical attention. It is a chronic disease and in most cases a degenerative problem that progresses as time goes by. These patients should be examined and followed up carefully by a skilled physician to prevent complications, and depending on the stage of the disease there will be a set of signs and symptoms. Thus, this list is only meant to be informative, and if you suspect liver disease, there are various tests your doctor needs to perform to evaluate your liver function.
In most cases, liver cirrhosis is a preventable disease, and controlling alcohol intake is an effective way to stop the progression of the disease, along with following indications in your diet and daily medications by your healthcare professional.