From the Guidelines
The initial symptoms of liver cirrhosis are often subtle and nonspecific, and may include fatigue, weakness, loss of appetite, nausea, mild weight loss, and abdominal discomfort or pain in the upper right side, as well as spider-like blood vessels on the skin, redness on the palms of hands, or easy bruising due to decreased production of clotting factors. These symptoms occur because cirrhosis impairs the liver's ability to perform its vital functions, including filtering toxins, producing proteins, and processing nutrients. The liver becomes scarred and cannot effectively process blood flow, leading to portal hypertension and many of the complications associated with advanced cirrhosis.
Key Symptoms
- Fatigue and weakness
- Loss of appetite and nausea
- Mild weight loss and abdominal discomfort or pain in the upper right side
- Spider-like blood vessels on the skin (spider angiomas)
- Redness on the palms of hands (palmar erythema)
- Easy bruising due to decreased production of clotting factors As the disease progresses, more noticeable symptoms develop, such as jaundice (yellowing of the skin and eyes), fluid accumulation in the abdomen (ascites), swelling in the legs (edema), itchy skin, and confusion or drowsiness due to the buildup of toxins in the bloodstream 1. Regular medical check-ups are essential for those with risk factors such as alcohol use disorder, hepatitis infections, or fatty liver disease to detect cirrhosis early. The 1-year and 2-year survival rates of patients with decompensated cirrhosis complicated with ascites are significantly lower than those with compensated cirrhosis, highlighting the importance of early detection and treatment 1.
Importance of Early Detection
- Regular medical check-ups for those with risk factors
- Early detection and treatment can improve survival rates
- Decompensated cirrhosis has lower survival rates than compensated cirrhosis The clinical features of alcoholic liver disease, including fatty liver, alcoholic hepatitis, and liver cirrhosis, can vary in terms of symptoms, complications, and blood test results 1. However, the initial symptoms of liver cirrhosis are often similar, regardless of the underlying cause.
Clinical Features of Alcoholic Liver Disease
- Alcoholic fatty liver: mostly asymptomatic, hepatomegaly
- Alcoholic hepatitis: jaundice, fever, tender hepatomegaly
- Alcoholic liver cirrhosis: spider angioma, palmar erythema, jaundice
From the Research
Initial Symptoms of Liver Cirrhosis
The initial symptoms of liver cirrhosis can be nonspecific and may include:
- Abdominal pain
- Nausea
- Malaise
- Muscle cramps (approximately 64% prevalence) 2
- Pruritus (39%) 2
- Poor-quality sleep (63%) 2
- Sexual dysfunction (53%) 2
Physical Examination Findings
Physical examination of patients with cirrhosis may reveal a variety of findings, including:
- Hepatomegaly
- Splenomegaly
- Jaundice
- Ascites
- Encephalopathy
- Dilated abdominal wall veins
- Spider nevi
- Palmar erythema 3
Complications of Liver Cirrhosis
Cirrhosis can lead to several complications, including:
- Bleeding from collateral veins
- Ascites
- Hepatocellular carcinoma
- Encephalopathy
- Infection leading to organ failure 4
- Spontaneous bacterial peritonitis (annual incidence of 11% in patients with ascites) 2
- Hepatorenal syndrome (annual incidence of 8% in patients with ascites) 2
Diagnosis and Treatment
Cirrhosis can be diagnosed by liver biopsy or noninvasively using elastography 2. Treatment of cirrhosis and its complications may include:
- Nonselective β-blockers (carvedilol or propranolol) to reduce the risk of decompensation or death 2
- Combination aldosterone antagonist and loop diuretics to resolve ascites 2
- Lactulose to reduce mortality and risk of recurrent overt hepatic encephalopathy 2
- Terlipressin to improve the rate of reversal of hepatorenal syndrome 2
- Hydroxyzine to improve sleep dysfunction, pickle brine and taurine to reduce muscle cramps, and tadalafil to improve sexual dysfunction in men 2