Cirrhosis is a condition where the liver becomes permanently scarred, replacing healthy tissue with damaged scar tissue. This scarring interferes with the liver’s ability to perform functions like processing nutrients, filtering toxins, and producing proteins. When cirrhosis progresses to an advanced stage, called end-stage liver disease or decompensated cirrhosis, the liver can no longer adequately function, leading to severe complications. This extensive, irreversible damage impacts a person’s appearance and overall health.
External Manifestations
One noticeable external sign of end-stage cirrhosis is jaundice, a yellow discoloration of the skin and whites of the eyes. This occurs because the damaged liver struggles to process bilirubin, a yellow pigment from red blood cell breakdown. Its accumulation makes the skin and eyes appear yellow.
Fluid accumulation in the abdomen, known as ascites, is a prominent external manifestation. This occurs due to increased pressure in blood vessels leading to the liver (portal hypertension) and the liver’s reduced production of albumin, a protein that helps keep fluid within blood vessels. The fluid leaks into the abdominal cavity, causing swelling and distension.
Muscle wasting, a noticeable loss of muscle mass, often appears in individuals with advanced cirrhosis, particularly in the limbs and face. This is due to altered metabolism and the liver’s impaired ability to process energy, leading to muscle breakdown for fuel. Decreased muscle mass can contribute to weakness and frailty.
Spider angiomas, small, spider-like blood vessels visible on the skin, especially on the chest and face, can develop. These are caused by a hormonal imbalance the diseased liver can no longer properly metabolize. Palmar erythema, a blotchy redness on the palms, is another visible sign related to hormonal imbalances.
Finger clubbing, where fingertips and nails become wider and curved, and white nails can be observed. These changes are associated with chronic oxygen deprivation and circulatory changes in advanced liver disease. They reflect the severe systemic impact of end-stage cirrhosis.
Impact on Body Functions
People with end-stage cirrhosis experience profound chronic fatigue and weakness, impacting daily life. The damaged liver’s inability to metabolize nutrients and produce energy contributes to persistent exhaustion. This debilitating lack of energy can make simple tasks challenging.
Easy bruising and bleeding are common internal symptoms, stemming from the liver’s impaired ability to produce clotting factors. The liver synthesizes proteins necessary for blood coagulation; when its function declines, the blood’s ability to clot is compromised. This can lead to prolonged bleeding from minor cuts or nosebleeds, and bruising from minimal trauma.
Intense itching, known as pruritus, is a distressing symptom experienced by many with end-stage cirrhosis. This sensation is caused by the accumulation of bile salts under the skin, which the diseased liver cannot adequately excrete. The itching can be severe and widespread, leading to skin irritation from scratching.
Changes in mental status or confusion, called hepatic encephalopathy, can develop as the liver’s filtering function deteriorates. The liver normally removes toxins like ammonia from the bloodstream. When it fails, these toxins build up and travel to the brain, affecting brain function. This can manifest as forgetfulness, difficulty concentrating, disorientation, slurred speech, or personality changes, ranging from mild confusion to coma.
The liver’s widespread roles affect almost every body system. Its declining metabolic, synthetic, and detoxification functions lead to a cascade of symptoms affecting physical and cognitive well-being. This reflects advanced liver damage.
Defining Complications
Variceal bleeding is a life-threatening complication in end-stage cirrhosis, arising from portal hypertension. Liver scarring impedes normal blood flow, causing blood to back up into the portal vein system and increasing pressure. This forces blood into smaller, fragile veins in the esophagus and stomach, forming enlarged varices. These varices are prone to rupture, leading to severe internal bleeding that requires immediate medical intervention.
Spontaneous bacterial peritonitis (SBP) is a serious infection that can occur in abdominal fluid (ascites) in people with advanced cirrhosis. A weakened immune system combined with fluid buildup creates an environment susceptible to bacterial growth. This infection often develops without an obvious source, leading to symptoms like fever, abdominal pain, and worsening mental status. SBP is a common cause of illness and death in individuals with end-stage liver disease and requires prompt antibiotic treatment.
Hepatorenal syndrome (HRS) is a severe form of kidney failure that can develop in individuals with advanced liver disease. This complication occurs when the kidneys cease to function properly due to changes in blood flow and pressure caused by liver failure. The liver’s inability to regulate circulatory function leads to constriction of blood vessels supplying the kidneys, reducing blood flow. This results in a rapid decline in kidney function, marked by reduced urine output and waste product buildup. HRS is a serious complication, indicating systemic dysfunction and a poor prognosis.