Symptoms of end stage cirrhosis: Message from death

The presence of symptoms of end-stage cirrhosis signals that this organ has been severely damaged and is no longer able to perform its usual tasks.

Cirrhosis carries the risk of permanent scarring. The factors that lead to cirrhosis are relatively many, including:

• Abuse of alcoholic beverages
• Viral infections that cause hepatitis B and C
• Fatty liver due to alcohol
• Other conditions such as drug side effects, infections or autoimmune disease

You may be interested in: Alcoholic Cirrhosis: No One's Own Story.

Symptoms of end stage cirrhosis

The appearance of symptoms of end-stage cirrhosis signals that the damage to this organ is so severe that it causes impaired liver function. This means that the liver is no longer able to handle daily tasks, including:

• Detoxify the body
• Blood purification
• Synthesis of several important proteins, blood components and nutrients

Fluid imbalance

Experts rate ascites, a condition where fluid builds up in the abdomen, as one of the most common symptoms of end-stage cirrhosis. This phenomenon is often uncomfortable and makes it difficult for the patient to breathe. Ascites is the result of elevated blood pressure in the capillaries leading to the liver and portal vein, also known as portal hypertension.

The liver also loses its ability to produce albumin, a protein that helps keep fluid from leaking from the blood vessels. Edema, a condition where fluid builds up in the legs or feet, may also occur. This makes it difficult to walk.

You may want to learn: Portal hypertension: a common but little known disease.

Hemorrhage

When scar tissue in the liver impedes blood flow, portal hypertension occurs and leads to esophageal varices over time. If not treated promptly, capillaries burst, hemorrhage occurs and becomes a potentially life-threatening emergency.

A deficiency of clotting factors, because the damaged liver cannot continue to produce them, also contributes to bleeding. Vomiting of blood or tarry stools can also be considered a symptom of end-stage cirrhosis because it represents esophageal varices.

Neurological signs

When the liver loses its ability to detoxify the body, toxic compounds like ammonia build up in the blood and circulate to the brain, leading to changes in the nervous system and even causing hepatic encephalopathy. Confusion, difficulty concentrating, and forgetfulness are early signs of this condition. Over time, symptoms can become more severe, such as personality changes or easily agitated. The worst consequences of hepatic encephalopathy are deep coma and death.

Infection

Another symptom of end-stage cirrhosis is infection. The presence of ascites increases the risk of developing another life-threatening condition called idiopathic bacterial peritonitis (or SBP), a bacterial infection that leads to inflammation of the membranes lining the abdomen. 65% of people with bleeding problems will develop spontaneous bacterial peritonitis. Some other signs that are also likely to appear include:

• Fever
• Chills
• Stomachache
• Confusion
• Nausea
• Athritis

CKD

The occurrence of spontaneous bacterial peritonitis and portal hypertension can lead to hepatorenal syndrome, which is potentially life-threatening. This is the result of reduced blood flow to the kidneys, leading to kidney failure. Warning signs often include:

• Dark urine
• Urinate less
• Nausea and vomiting
• Convulsions
• Confusion
• Delirium