Advanced liver disease manifests itself in various ways. Effects of the disease are usually caused by the development of portal hypertension (increased pressure in the portal vein) and include:
- Gastroesophageal varices and bleeding – esophageal varices are abnormally enlarged veins in the lower part of the esophagus, which can cause bleeding in both the upper and lower GI tract.
- Ascites – the presence of excess fluid in the abdominal cavity and frequently develops in patients with chronic liver disease.
- Spontaneous bacterial peritonitis (SBP) – SBP is often seen in patients with cirrhosis and ascites and refers to bacterial infection of the ascitic fluid without the presence of a surgically treatable cause.
- Hepatic encephalopathy (HE) – refers to the state of confusion induced by high serum ammonia levels.
- Hepatorenal syndrome (HRS) – is decreased renal function as a consequence of cirrhosis and reflects the severity of the liver disease and the urgency for liver transplant consideration.
- Hepatopulmonary syndrome (HPS) – patients usually present with cyanosis (bluish discoloration of skin) and clubbing (enlargement of the finger tips).
- Porto pulmonary hypertension (PPHTN) – is a pulmonary vascular disorder seen in patients with portal hypertension.
- Hypersplenism – enlargement of the spleen due to portal hypertension can cause decreased platelets and white blood cells in the peripheral blood, making the cirrhotic patient prone to easy bleeding and some infections.
Clinical manifestations of cirrhosis unrelated to portal hypertension include:
- Coagulopathy – is caused by deficient production of blood coagulation factors by the cirrhotic liver.
- Jaundice – jaundice is a yellowish discoloration of the skin and eyes that occurs when the diseased liver does not secrete enough bilirubin.
- Itching – itching usually becomes a significant problem in patients with cholestatic liver diseases i.e., PBC, PSC.
- Edema – accumulation of fluid in the arms and legs occurs when the liver loses its ability to make the protein albumin.
- Hepatocellular carcinoma – is a primary liver tumor commonly caused by cirrhosis usually in the setting of Hepatitis B and C, although it can occur in cirrhosis from any cause.
- Sensitivity to medication – cirrhosis decreases liver's ability to metabolize medications from the blood.