The American Academy of Family Physicians states that cirrhosis often becomes a silent killer because symptoms often fail to occur until significant and permanent damage occurs. During this destruction, normal liver tissue gets replaced by tough scar tissue and the liver slowly loses function over time. Symptoms arise due to the dysfunction of the many tasks the liver normally performs.
Symptoms of Malunutrition
A large job done by the liver is the metabolism of nutrients and vitamins such as protein and vitamin D. Without the ability to metabolize properly the body becomes malnourished and symptoms begin to occur. Symptoms of malnourishment with cirrhosis include bone loss, fatigue, weakness, loss of appetite and weight, and greasy pale-colored stools. Patients also experience nausea, vomiting, indigestion, and excess gas also furthering loss of appetite.
Skin and Nail Changes
Several skin and nail changes result as the liver damage from cirrhosis occurs. The Merck Manual Home Edition lists bumps on the skin, spider veins, dry itchy skin and reddened palms. Nails often develop white lines alternating with pink or red bands. Jaundice occurs due to the buildup of billirubin and causes the skin to turn yellow or orange. Eyes also turn yellow and sometimes show a green halo around the iris.
Swelling and Abdominal Discomfort
Joel J. Heidelbaugh and Michael Bruderly report in a September 2006 article in "American Family Physician" that approximately 85 percent of people with cirrhosis develop a condition called ascites. This condition occurs when the liver becomes overloaded with fluid and this fluid leaks into the abdomen, causing swelling. This causes bloating, pain and shortness of breath. In addition, legs and feet swell as a result of fluid backups in the body.
Confusion
Hepatic encephalopathy describes a common condition in cirrhosis that causes many changes in mental status. This condition occurs when toxins, particularly ammonia, build up in the blood due to the liver's inability to rid the body of excess toxins. According to "Medical Surgical Nursing," some symptoms of hepatic encephalopathy are impaired judgment, behavior changes, drowsiness, confusion, delirium, rapid mood swings, slow thought processes and slurred speech. At the end of the disease process this condition causes coma and death.
Bleeding
Two conditions of impaired liver function lead to increased risk for bleeding. Blood backs up from the portal vein in the liver into the veins in the digestive system. As a result these veins become weak and may rupture, causing bleeding in the stomach, esophagus or intestines. The blood also becomes thinner than normal due to the malabsorption of vitamin K which is necessary for the clotting of blood.
References
- Merck Manual Home Edition: Cirrhosis
- "American Family Physician": Cirrhosis and Chronic Liver Failure Part I
- "American Family Physician": Cirrhosis and Chronic Liver Failure Part II
- "Medical Surgical Nursing"; D. Ignatavicius, MSN, L. Workman, PhD.; 2002
