You are not likely to feel any symptoms of cirrhosis early on. In fact, many people with cirrhosis only find out during tests for an unrelated illness. Additionally, the symptoms can be very non-specific, meaning that they are also caused by other conditions not related to cirrhosis.
If you have cirrhosis, you may develop one or more of the symptoms below. If you have or are worried about any of these symptoms discuss them with your doctor
- generally feeling unwell and tired all the time
- loss of appetite
- loss of weight and muscle wasting
- feeling sick (nausea) and vomiting
- tenderness/pain in the liver area
- spider-like small blood capillaries on the skin above waist level (spider angiomas)
- blotchy red palms
- disturbed sleep pattern
- intensely itchy skin
- yellowing of the whites of the eyes and the skin (jaundice)
- white nails
- ends of fingers become wider/thicker (clubbed fingers)
- hair loss
- swelling of the legs, ankles, feet (oedema)
- swelling of the abdomen (ascites)
- dark urine
- pale-coloured stools or very dark/black tarry stools
- frequent nosebleeds and bleeding gums
- easy bruising and diffi culty in stopping small bleeds
- vomiting blood
- frequent muscle cramps
- right shoulder pain
- in men: enlarged breasts and shrunken testes
- in women: irregular or lack of menstrual periods
- impotence and loss of sexual desire
- dizziness and extreme fatigue (anaemia)
- shortness of breath
- very rapid heartbeat (tachycardia)
- fevers with high temperature and shivers
- forgetfulness, memory loss, confusion and drowsiness
- subtle change in personality
- trembling hands
- writing becomes difficult, spidery and small
- staggering gait when walking; tendency to fall
- increased sensitivity to drugs, both medical and recreational
- increased sensitivity to alcohol
If you have any of the following symptoms you must see a doctor straight away, especially if you have recently been diagnosed with cirrhosis:
- fever with high temperatures and shivers, often caused by an infection
- shortness of breath
- vomiting blood
- very dark or black tarry stools (faeces)
- periods of mental confusion or drowsiness.
Although these symptoms may seem very different, because your liver is responsible for so many different functions, if it stops working properly, a range of problems can result.
Here is an explanation of the causes of some of the key symptoms of cirrhosis.
If your skin and the whites of your eyes turn yellow you may have jaundice.
Two things can cause jaundice:
- a blockage (obstruction) in the bile duct
- damage to your liver or some defect affecting the liver so that it cannot deal with bilirubin, a by-product of the breakdown of old red blood cells.
If either of these occurs, bilirubin – which is yellow – flows back into the blood and shows up in the skin and the eyes.
Swelling in your abdomen is known as ascites. The swelling is caused by fluid building up in the lining around your abdomen. This can happen slowly over weeks or months and can be painful, especially if the fluid becomes infected and requires urgent attention.
You may also get swelling in your legs, ankles or feet, known as peripheral oedema.
People with cirrhosis are prone to infections, which can make their liver condition worse. As a result, they should seek medical attention if they develop a temperature.
Internal bleeding due to liver damage is often first noticed in very dark or black tarry faeces (maelena) and the vomiting of blood (haematemesis). Having either of these symptoms will need urgent medical attention.
If your liver is badly scarred from extensive fibrosis or cirrhosis, blood will be unable to flow through it easily. As a result, pressure builds up in the vein that carries blood to the liver from the gut – the portal vein.
Having high blood pressure in the portal vein is known as portal hypertension. As the pressure mounts, blood begins to back up. It finds another way of reaching the heart by using extra veins
lining your oesophagus and stomach known as varices. Varices have fragile walls, which cannot easily handle the increased blood flow and often burst, leading to internal bleeding.
This blood loss may just be a gentle ooze, resulting in symptoms of anaemia that include tiredness and shortness of breath, but sometimes there can be major bleeding, with a haemorrhage and vomiting of blood. Haemorrhaging varices are a serious and life-threatening complication of cirrhosis and need emergency medical treatment.
It is not always easy to diagnose cirrhosis. A doctor will take a careful medical history, carry out a physical examination and make plans for further tests.
The tests for cirrhosis include:
A blood test among other things measures liver function and damage. These are most commonly Liver Function Tests (LFTs). These are used to gain an idea of how the different parts of your liver are functioning.
The liver function test is made up of a number of separate examinations, each looking at different properties of your blood. It is used to gain an indication of how much your liver is inflamed or unable to work properly. The test will measure, for example, levels of the liver enzymes ALT and AST as these are increased during inflammation (hepatitis).
It will also look at how well your blood clots (referred to as INR time) and how well your kidneys remove a product called creatinine. These are good indicators for how well your liver is working, and how this is affecting the rest of your body.
These are tests in which your liver may be scanned using ultrasound, computerised tomography (CT) or magnetic resonance imaging (MRI).
Ultrasound, the same technology used to confirm all is well in pregnancy, sends sound waves into your body. The echoes are picked up and used to build a picture of the condition of the liver.
MRI and CT provide a detailed view of your internal organs and are able to generate very detailed cross-sectioned images (or ‘slices’) of your body area.
With these tests, a tiny piece of the liver is taken to be looked at under a microscope. A fine hollow needle is passed through the skin into the liver and a small sample is withdrawn. The test is usually done under local anaesthetic and may mean an overnight stay in hospital, although most people are allowed home later the same day if they live close by.
An endoscopy is when, following sedation, a thin flexible tube with a light and a tiny camera on the end (endoscope) is passed down your oesophagus and into your stomach. This is to check for varices in the oesophagus or stomach which may rupture and suddenly bleed.
Cirrhosis is sometimes called end stage liver disease. This simply means it comes after the other stages of liver damage which can include inflammation (hepatitis), fatty deposits (steatosis) and increased stiffness and mild-scarring of your liver (fibrosis).
Many people with cirrhosis can feel quite well and live for many years without needing a liver transplant. This is because the liver can function relatively well even when it is quite severely damaged.
Cirrhosis is classified as compensated or decompensated. Compensated cirrhosis is where the liver is coping with the damage and maintaining its important functions. In decompensated cirrhosis, the liver is not able to perform all its functions adequately. People with decompensated liver disease or cirrhosis often have serious symptoms and complications such as portal hypertension, bleeding varices, ascites and encephalopathy.
There are also systems for grading cirrhosis according to its severity. One of these is the Childs Pugh Score, which uses symptoms including encephalopathy and ascites together with blood test results for bilirubin, albumin and clotting, to grade cirrhosis from A (relatively mild) to C (severe). There are other systems including MELD (model of end-stage liver disease) which are used to help decide which patients most urgently need liver transplants. It uses blood test results for bilirubin, creatinine and clotting (INR)