Liver disease known as cirrhosis commonly occurs in two stages, compensated and decompensated. In first stage of liver damage, the liver still has the ability to function normally or compensate for the damage. When extensive damage occurs and the liver can no longer function normally, decompensation occurs. According to the Hepatitis C Trust, an awareness group in the UK, up to 80 to 90 percent of the liver becomes permanently damaged before decompensated cirrhosis occurs. Complications occur due to the disruptions in function of the liver.
Jaundice
During the decompensation stages of liver disease, skin takes on a yellow or orange appearance. The sclera, or whites, of the eyes also become yellow. This condition, called jaundice, occurs due to the build up of a substance called bilirubin. This occurs either because the liver becomes so damaged it no longer processes bilirubin or because the bile duct becomes blocked, causing a build-up of bilirubin in the liver.
Bleeding
A condition known as portal hypertension, high blood pressure in the portal vein of the liver, causes veins in the gastrointestinal system to become distended. These bulging vessels are referred to as varices. According to the American Academy of Family Physicians, 50 percent of patients with cirrhosis develop varices. These fragile vessels consist of thin walls that commonly rupture and bleed. The risk of bleeding also increases due to the liver's inability to metabolize vitamin K which aids in the clotting of blood. When blood becomes too thin and cannot clot, risk for bleeding increases.
Ascites
The most common condition that occurs with decompensation in liver disease is fluid build-up in the abdomen, known as ascites. The American Academy of Family Physicians reports that 85 percent of patients with cirrhosis develop ascites. Fluids such as plasma and lymph collects in the abdominal cavity and becomes trapped. This fluid causes pressure, tightness, pain, bloating, a full feeling and shortness of breath.
Hepatic Encephalopathy
The liver metabolizes and breaks down many substances, vitamins and nutrients. Protein is broken down into glutamine and ammonia. In the decompensated stage of liver disease, the liver becomes unable to break down and rid the body of ammonia. Toxic levels build in the blood and brain, causing a condition known as hepatic encephalopathy. Symptoms of this condition include behavior and personality changes, fatigue, drowsiness, slurred speech, confusion, disorientation and muscle twitching. In the last stage of hepatic encephalopathy, seizures, coma and death occur.
Other Symptoms
Bacterial peritonitis, an infection of ascites fluid, is a common complication of decompensated cirrhosis. Other conditions include kidney failure; anemia; spider veins on the skin; nausea; vomiting; diarrhea; loss of appetite and weight; bruising; and pale/clay colored stools.
References
- "Medical Surgical Nursing" Ignatavicius, D. MSN, Workman, L. PhD.; 2002
- American Acadmey of Family Physicians: Cirrhosis and Chronic Liver Failure Part II
- Hepatitis C Trust: Decompensated Cirrhosis
