WHAT ARE THE SYMPTOMS OF CIRRHOSIS?

Many people experience few symptoms at the onset of cirrhosis.

Early symptoms include the following:

Fatigue and loss of energy.
Loss of appetite and nausea.
Spider angiomas may develop on the skin; these are pinhead-sized red spots
from which tiny blood vessels radiate.

Patients in later stages may develop the following symptoms:

Jaundice. This is a yellowish cast to the skin and eyes, which occurs because
the liver cannot process bilirubin for elimination from the body.
The palms of the hands may be reddish and blotchy, a condition known as
palmar erythema.
Loss of body hair.
Abnormalities in hormone-affected organs. In men with alcoholic cirrhosis,
the testicles may atrophy and their breasts may become swollen, sometimes
painfully.
Ascites. A swollen belly is a sign of ascites, the most common major
complication of cirrhosis, which occurs when fluid accumulates in the abdomen.
Fever, abdominal pain, and tenderness when the belly is pressed indicate that
the fluid is infected, but infection can occur without any symptoms.
Fluid buildup and swelling (edema) in legs.
Symptoms of Primary Biliary Cirrhosis
People with primary biliary cirrhosis are subject to severe generalized itching
and often develop small fatty yellow lumps called xanthomas on the eyelids,
hands, and elbows. They may have an unpleasant condition called steatorrhea, in
which the feces contain excessive fat, causing them to float and to be very foul
smelling.


HOW SERIOUS IS CIRRHOSIS?

Cirrhosis is the seventh leading cause of death by disease in the US, killing
more than 25,000 people each year. A damaged liver affects almost every bodily
process, including the functions of the digestive, hormonal, and circulatory
systems. The most serious complications are those associated with so-called
decompensation, which occur when cirrhosis progresses. They include the
following:

Bleeding and fluid buildup (ascites).
Infections.
Damage to the brain (encephalopathy). Impaired brain function occurs when the
liver cannot detoxify harmful substances.

Liver cancer is also a long-term risk with cirrhosis.

Cirrhosis is irreversible, but the rate of progression can be very slow,
depending on its cause and other factors. Five-year survival rates are about 85%
and can be lower or higher depending on severity.

For example, for alcoholics with cirrhosis who abstain, a survival rate of
five years or more can be as high as 85%. For those who continue drinking, the
chance for living beyond five years is no higher than 60%.
In patients with hepatitis B or C, the five-year survival rate after a
diagnosis of cirrhosis ranges between 71% to 85%.
About two-thirds of patients with primary biliary cirrhosis never develop
symptoms and can have a normal life span. Once symptoms of liver damage, such as
jaundice, occur, however, the average survival time declines. In one study of
women diagnosed with primary biliary cirrhosis, about 36% developed symptoms
over an 11-year period, and 11% either died or required liver transplantation.

Unfortunately, physicians are usually unable to determine when cirrhosis first
occurred, which makes it difficult to determine prognosis.
Portal Hypertension
In cirrhosis, liver cell damage slows down blood flow. This causes a backup of
blood through the portal vein, a condition called portal hypertension. The
effects of portal hypertension can be widespread and serious, including fluid
buildup and bleeding.

Ascites and Fluid Buildup. Ascites is fluid buildup in the abdomen. It is
uncomfortable and can reduce breathing function and urination. Ascites is
usually caused by portal hypertension, but it can result from other conditions.
Swelling can also occur in the arms and legs and in the spleen. Although ascites
itself is not fatal, it is a marker for severe progression. Once ascites occurs,
only half of patients survive after two years. In fact, some experts refer to
the phases of cirrhosis as preascitic and ascitic. Some physicians even believe
that ascites signals the need for liver transplantation, particularly in
alcoholic cirrhosis.

Variceal Bleeding. One of the most serious repercussions of portal hypertension
is the development of varices, which are blood vessels that enlarge to provide
an alternative pathway for blood diverted from the liver. In about two-thirds of
patients they form in esophagus (the "food pipe"). They pose a high risk for
rupture and bleeding because of the following characteristics:

They are thin-walled.
They are often twisted.
They are subject to high pressure.
Internal bleeding from these varices (variceal bleeding) occurs in 20% to 30%
of cirrhosis patients. The risk of death from a single episode can reach 70%.

Bleeding commonly recurs within two weeks of the first episode, but after six
weeks, the risk for recurrence is the same as for patients who have not had a
bleeding event.

Factors that predict variceal bleeding in general include the following:

Ascites.
Encephalopathy.
Large veins.

Factors that can increase the danger for a bleeding episode in high-risk
individuals include the following:

Moderate to intense exercise.
Bacterial infection.
Certain times of the day. Eating increases portal pressure, and there is a
greater risk for bleeding in the evening. A lesser but still significant risk
occurs in the early morning.

It is important for patients to be screened for esophageal varices and treated
with preventive beta blockers if they show signs of risk. Between 30% and 40% of
patients with cirrhosis experience bleeding, which carries a mortality rate of
between 20% and 35%. Some experts recommend that all newly diagnosed patients be
screened using endoscopy. Screening should also be considered for all previously
diagnosed patients who have not been screened but would benefit from preventive
treatments.
Gastrointestinal Bleeding
Gastrointestinal (GI) bleeding can occur from abnormal blood clotting, which can
be result of a combination of complications associated with cirrhosis. They
include vitamin K deficiencies and thrombocytopenia -- a drop in platelets (the
blood cells that normally initiate the clotting process). Some research now
suggests that thrombocytopenia itself may be associated with more advanced liver
failure.
Infections
Bacterial infections are very common in advanced cirrhosis, and may even
increase the risk for bleeding. Most bacterial infections, including those in
the urinary, respiratory, or gastrointestinal tracts, develop when patients are
in the hospital. Abdominal infections are a particular problem in cirrhosis and
occur in up to 25% of patients with cirrhosis within a year of diagnosis.
Mental Impairment and Encephalopathy
Mental impairment is a common event in advanced cirrhosis. In severe cases, the
disease causes encephalopathy (damage to the brain), with mental symptoms that
range from confusion to coma and death. A combination of conditions associated
with cirrhosis causes this serious complication:

Buildup in the blood of harmful intestinal toxins, particularly ammonia.
An imbalance of amino acids that effect the central nervous system.

Encephalopathy is often triggered by certain conditions, including the
following:

Gastrointestinal bleeding.
Constipation.
Excessive dietary protein.
Infection.
Surgery.
Dehydration.

Alcoholics with cirrhosis are believed to be at higher risk for this
complication than with nonalcoholic cirrhosis, but one study suggested that
alcoholics simply tend to have more severe cirrhosis.

Symptoms of Encephalopathy. Early symptoms of hepatic encephalopathy include
forgetfulness, unresponsiveness, and trouble concentrating. Sudden changes in
the patient's mental state, including agitation or confusion, may indicate an
emergency condition. Other symptoms include bad fruity-smelling breath and
tremor. Late stage symptoms of encephalopathy are stupor and eventually coma.
Hepatorenal Syndrome
Hepatorenal syndrome occurs if the kidneys drastically reduce their own blood
flow in response to the altered blood flow in the liver. It is a
life-threatening complication of late-stage liver disease that occurs in
patients with ascites. Symptoms include dark colored urine and a reduction in
volume, yellowish skin, abdominal swelling, mental changes (delirium,
confusion), jerking or coarse muscle movement, nausea, and vomiting.
Liver Cancer
Cirrhosis greatly increases the risk for liver cancer, regardless of the cause
of cirrhosis. Although few studies have been conducted on the risk for liver
cancer in patients with primary biliary cirrhosis, one study reported an
incidence of 2.3%. About 4% of patients with cirrhosis caused by hepatitis C
develop liver cancer. In Asia about 15% of people who have chronic hepatitis B
develop liver cancer, but this high rate is not seen in other parts of the
world. (One Italian study that followed a group of hepatitis B patients for 11
years found no liver cancer over that period of time.)
Osteoporosis
About 30% of patients with chronic liver disease develop osteoporosis (loss of
bone density), which is twice the usual incidence Primary biliary cirrhosis
poses a particularly high risk for osteoporosis. Treating osteoporosis in
patients with cirrhosis can be complicated. One study found that calcitriol (a
form of vitamin D) is especially helpful in preventing bone loss in patients
with cirrhosis.




Sandra Tara Balduf (Ane)

Frontline Hepatitis Awareness

Support for patients and educational materials

http://frontline-hepatitis-awareness.com

1-866-Hep-GoGo 866-437-4646




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