Cirrhosis consists of a permanent and progressive destruction of healthy liver tissue. Causes of cirrhosis vary widely, with alcoholism the most prevalent. In the final stages of cirrhosis, tough fibrous scarring replaces the once healthy tissue in the liver. Failure of this vital organ to handle its usual functions causes numerous possible complications that eventually lead to end of life. Symptoms and complications vary between patients, and not all symptoms affect every patient.
Ascites, Swelling and Infection
The damaged liver leaks fluids into the abdomen causing a condition known as ascites. This condition causes the abdomen to become distended as it fills with fluid. According to "Medical Surgical Nursing," this accumulation of fluid causes abdominal pain, bloating, and shortness of breath. Massive ascites also causes a cascade effect in the body which causes swelling in the feet and legs. The liver also functions to rid the body of infection. The liver's inability to remove infection increases risk of infection. The ascites fluid in the abdomen also commonly becomes infected and is called bacterial peritonitis.
Hepatic Encephalopathy
Another major function of the liver consists of ridding the body of toxins, drugs and nutrients. The National Institutes of Health describes this condition of buildup of toxins in the blood and brain due to end stage cirrhosis as hepatic encephalopathy. Hepatic encephalopathy causes slurred speech, rigid muscles and seizures. It affects thought processes and causes confusion, altered decision making, behavior changes, drowsiness, fatigue and eventually coma and death.
Jaundice and Skin Alterations
In end stage cirrhosis, the liver becomes unable to process a substance called billirubin. Jaundice occurs because of this buildup of billirubin and turns the skin a yellow or orange color. Sclera of the eyes also turns yellow. Other skin changes include the appearance of spider veins, bruising and dry, itchy skin.
Portal Hypertension and Bleeding
High blood pressures in the portal vein of the liver, portal hypertension, causes a narrowing or blockage of blood flow. As a result, blood backs up and dilates the veins in the stomach, esophagus and intestines. The American Academy of Family Physicians reports that approximately 50 percent of patients with cirrhosis develop bleeding of these veins. The veins in the esophagus are at highest risk of rupture and are commonly referred to as esophageal varices. The patient with end stage cirrhosis also becomes at higher risk for bleeding in any part of the body because of the liver's impaired ability to aid in the clotting of blood.
References
- "Medical Surgical Nursing" Ignatavicius, D. MSN, Workman, L. PhD.; 2002
- American Academy of Family Physicians: Cirrhosis and Chronic Liver Failure Part II
- National Institute of Health: Cirrhosis
