Cirrhosis of the liver signals permanent damage to the organ. Cirrhosis, or scarring, typically takes years to reveal itself and by the time symptoms become apparent, patients have chronic liver failure nearing the end-stage of the disease process. The function of the liver is vital for survival. The liver impacts, and is impacted by, the health of other organs in the body such as the kidneys and the brain. The symptoms presenting during the end stages of cirrhosis reflect this symbiotic relationship.
Skin Changes
The liver filters the blood. Liver cells damaged by cirrhosis cannot properly filter bile pigments from the blood. Jaundice, a yellowing of the skin, the whites of the eyes and the mucous membranes occurs. Donna D. Ignatavicius, MS RN, and M. Linda Workman, PhD, authors of the 2006 edition of "Medical-Surgical Nursing: Critical Thinking for Collaborative Care" explain that a cirrhosed liver can no longer process vitamins A, B, D and E. The skin becomes dry and itchy and rashes form. The palms of the hands become warm and bright red. Another end-stage cirrhosis skin change is the formation of visible bluish patches of veins called spider veins to the head, neck, chest, and abdomen.
Edema
In end-stage cirrhosis, fluid builds up in body tissues. Swelling, or edema, occurs in dependent body parts such as the lower extremities and the hands, or the back and sacrum when the patient is reclining or lying down.
Abdominal Pressure
The enlarged cirrhosed liver puts pressure on the blood vessels in the abdomen. Pressure inside the abdominal cavity causes fluid build-up inside the abdomen. This is called ascites. The pressure can cause hemorrhoids. It also affects the blood vessels in the esophagus, causing them to dilate and rupture which is a medical emergency.
Malnutrition
The liver is responsible for synthesizing, storing and processing vitamins, glucose and proteins. In end-stage cirrhosis, the liver can no longer carry out these functions and patients suffer malnutrition. Low blood levels of protein worsen ascites and edema. Patients experience nausea, vomiting, a lack of appetite, and when they eat, they cannot glean all the nutrients from the foods they consume.
Blood Disorders
The American Liver Foundation reports that patients with end-stage cirrhosis experience low levels of red blood cells which causes anemia and is characterized by weakness and shortness of breath. Impaired platelet production and the inability of the liver to synthesize vitamin K increases a patient's bleeding risk. Patients experience bruising and can hemorrhage.
Altered Mental Functioning
A build up in the blood of toxins and ammonia affect mental functioning and cause hepatic encephalopathy. Characterized by lethargy, confusion, seizures and coma, death can occur even with critical care.
Multiple Organ Failure
Because liver health and function impacts other organs, end stage cirrhosis causes kidney failure and interferes with the proper functioning of the pancreas, brain, heart and lungs. Difficulty breathing, diabetes, irregular heart rhythms and encephalopathy can lead to death.
References
- "Medical-Surgical Nursing: Critical Thinking for Collaborative Care"; Donna D. Ignatavicius & M. Linda Workman; 2006
- American Liver Foundation: The Progression of Liver Disease
- MayoClinic.com: Hepatitis C: What happens in End-Stage Liver Disease?
