Cirrhosis of the liver is a condition that causes permanent scarring of the liver. While a number of contributors can lead to cirrhosis, the main causes are alcohol, viral infections with hepatitis B and C and fatty liver disease due to alcohol abuse or other conditions such as medications, infections and autoimmune diseases. When symptoms of end-stage cirrhosis appear, the damage to the liver is so severe that the organ can no longer function properly to detoxify the body, purify the blood and synthesize a number of vital proteins, blood components and nutrients.
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Ascites or fluid accumulation in the abdomen is one of the signs of advanced cirrhosis. This buildup of fluid can be uncomfortable and cause difficulty breathing. Fluid seeps into the abdomen because of increased pressure in the blood vessels leading to the liver and portal vein -- a condition called portal hypertension. In addition, the liver is no longer able to produce albumin, a protein that helps to keep fluid from leaking from blood vessels. Edema or fluid in the legs and feet can also occur and can be so severe that walking can be difficult.
When blood can no longer flow easily through the liver due to scarring and resultant portal hypertension, veins in other organs such as the stomach and esophagus enlarge. These vessels can easily rupture and bleed, causing a life-threatening emergency. The loss of clotting factors that the damaged liver can no longer produce also contributes to the bleeding problem. Vomiting blood or passing black stools are common symptoms of these bleeding veins or varices.
As the liver loses its ability to detoxify the body, harmful chemicals such as ammonia build up in the blood and brain, leading to mental changes, or hepatic encephalopathy. Confusion, trouble concentrating and forgetfulness are early symptoms. Slurred speech, dramatic personality changes and agitation are examples of more severe symptoms. Eventually, encephalopathy can lead to coma and death.
The presence of ascites increases the risk of developing another life-threatening condition called spontaneous bacterial peritonitis, or SBP, a bacterial infection that leads to inflammation of the membrane lining the abdomen. Up to 65 percent of people who have bleeding problems will also develop SBP. Fever, chills and abdominal pain are the main symptoms, though confusion, nausea, vomiting and joint pain may also be present.
SBP and portal hypertension can both lead to hepatorenal syndrome. This life-threatening condition results from decreased blood flow to the kidneys, leading to kidney failure. Symptoms include dark-colored urine and decreased urine production, nausea, vomiting, jerking movements and confusion or delirium.
Prognosis and Treatment
When signs and symptoms of end-stage cirrhosis appear, the possibility of five years of survival is markedly decreased. While immediate treatment is aimed at managing symptoms and preventing additional complications, when most people reach this advanced stage of liver disease, they are usually referred for liver transplantation.