You may not have any or only a few of the complications or you may have all of the complications shown in this section. Everyone is different. This list is only to show you what CANhappen. If you think you are having any of theses complications, see your doctor. Complications of cirrhosis can include:
Ascites & Edema: As cirrhosis of the liver becomes severe, signals are sent to the kidneys to retain salt and water in the body. The excess salt and water first accumulates in the tissue beneath the skin of the ankles and legs because of the effect of gravity when standing or sitting. This accumulation of fluid is called edema or pitting edema. (Pitting edema refers to the fact that pressing a fingertip firmly against an ankle or leg with edema causes an indentation in the skin that persists for some time after release of the pressure. Actually, any type of pressure, such as from the elastic band of a sock, may be enough to cause pitting.) The swelling often is worse at the end of a day after standing or sitting and may lessen overnight as a result of the loss of the effects of gravity when lying down. As cirrhosis worsens and more salt and water are retained, fluid also may accumulate in the abdominal cavity between the abdominal wall and the abdominal organs. This accumulation of fluid (called ascites) causes swelling of the abdomen, abdominal discomfort, and increased weight.Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity (abdomen). See separate "Ascites" page for more information.
Bruising & Bleeding: When the liver slows or stops producing the proteins needed for blood clotting, a person will bruise or bleed easily almost anywhere on their body.
Esophageal Varices & Gastropathy: Portal hypertension may cause enlarged blood vessels in the esophagus, called varices, or in the stomach, called gastropathy, or both. Enlarged blood vessels are more likely to burst due to thin walls and increased pressure. Serious bleeding can then occur in the esophagus or upper stomach, requiring immediate medical attention. See separate "Esophageal Varices" page for more information.
Gallstones:If cirrhosis prevents bile from flowing freely to and from the gallbladder, the bile hardens as gallstones.
Hepatic Encephalopathy (HE): A failing liver cannot remove toxins from the blood eventually accumulating in the brain. The buildup of toxins in the brain—called hepatic encephalopathy—can decrease mental function and cause coma. Signs of decreased mental function include confusion, personality changes, memory loss, trouble concentrating, and a change in sleep habits. See separate "Hepatic Encephalopathy" page for more information.
Hepatorenal Syndrome: Patients with worsening cirrhosis can develop hepatorenal syndrome, which is a serious complication in which the function of the kidneys is reduced. It is a functional problem in the kidneys, that is, there is no physical damage to the kidneys. Instead, the reduced function is due to changes in the way the blood flows through the kidneys themselves.
Hepatorenal syndrome is defined as progressive failure by the kidneys to clear substances from the blood and produce adequate amounts of urine. Other important functions of the kidney, such as retention of salt, are usually maintained. If liver function improves or a healthy liver is transplanted into a patient with hepatorenal syndrome, the kidneys usually begin to work normally. This suggests that the reduced function of the kidneys is also the result of the accumulation of toxic substances in the blood. There are two types of hepatorenal syndrome. One type occurs gradually over months. The other occurs rapidly over a week or two.
Hepatopulmonary Syndrome: Rarely, some patients with advanced cirrhosis can develop hepatopulmonary syndrome. These patients can experience difficulty breathing because certain hormones released in advanced cirrhosis cause the lungs to function abnormally. The basic problem in the lung is that not enough blood flows through the small blood vessels in the lungs that are in contact with the alveoli (air sacs) of the lungs. Blood flowing through the lungs is shunted around the alveoli and cannot pick up enough oxygen from the air in the alveoli. As a result the patient experiences shortness of breath, particularly with exertion.
Hypersplenism: is a type of disorder that causes the spleen to rapidly and prematurely destroy blood cells. The spleen is located in the upper left area of the abdomen. One of this organ's major functions is to remove red blood cells, white blood cells, and platelets (small particles that are important for the clotting of blood) from the body's bloodstream. In hypersplenism, its normal function accelerates, and it begins to automatically remove cells that may still be normal in function. Sometimes, the spleen will temporarily hold onto up to 90% of the body's platelets and 45% of the red blood cells. Hypersplenism is sometimes referred to as enlarged spleen (splenomegaly). An enlarged spleen is one of the symptoms of hypersplenism. What differentiates hypersplenism is its premature destruction of blood cells. Sometimes, as the pressure in the portal vein rises in cirrhosis, it increasingly blocks the flow of blood from the spleen. The blood "backs-up" and accumulates in the spleen, and the spleen swells in size, also resulting in splenomegaly.
Liver Cancer (HepatoCellular Carcinoma-HCC): Cirrhosis, due to any cause, increases the risk of primary liver cancer. Primary refers to the fact that the tumor originates in the liver. A secondary liver cancer is one that originates elsewhere in the body and spreads (metastasizes) to the liver.
The most common symptoms and signs of primary liver cancer are abdominal pain and swelling, an enlarged liver, weight loss, and fever. In addition, liver cancers can produce and release a number of substances, including ones that cause an increased in red blood cell count (erythrocytosis), low blood sugar (hypoglycemia), and high blood calcium (hypercalcemia). See separate "Liver Cancer" page for more information.
Insulin Resistance & Type 2 Diabetes: Cirrhosis causes resistance to insulin—a hormone produced by the pancreas that enables the body to use glucose as energy. With insulin resistance, the body’s muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulin by producing more, but excess glucose builds up in the bloodstream causing type 2 diabetes.
Jaundice: Jaundice occurs when the diseased liver does not remove enough bilirubin from the blood, causing yellowing of the skin and whites of the eyes and darkening of the urine. Bilirubin is the pigment that gives bile its reddish-yellow color.
Liver Cancer: Hepatocellular carcinoma is a type of liver cancer that can occur in people with cirrhosis. Hepatocellular carcinoma has a high mortality rate, but several treatment options are available.
Medication Sensitivity: Cirrhosis slows the liver’s ability to filter medications from the blood. When this occurs, medications act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side effects.
Portal Hypertension: Normally, blood from the intestines and spleen is carried to the liver through the portal vein. But cirrhosis slows the normal flow of blood, which increases the pressure in the portal vein. This condition is called portal hypertension.
Portal Vein Thrombosis (PVT): A potentially deadly condition with very few recognizable symptoms. PVT is a blood clot in the hepatic portal vein, a major abdominal vein that runs from the bowel and other organs to the liver. In approximately one of three instances, the blockage forms slowly and the body is able to create secondary blood vessels, called collaterals, that can bypass the block. PVT generally does not damage the liver itself. The damage is actually the result of a buildup of blood in the other organs connected to the vein.
There are several possible causes of PVT. Damage to the liver is the most common cause. Cirrhosis, trauma or cancer in the liver or nearby areas of the abdomen can lead to this condition. Pancreatitis, clotting disorders and dehydration can also cause a blood clot in the hepatic vein. Other possible causes include estrogen treatment, dehydration, malnutrition and sepsis.
People with PVT often do not know of the blockage in the hepatic portal vein until after it results in a serious medical emergency. The only early symptoms are abdominal pain, nausea, or a fever, all of which may mask the condition of PVT. It is not until the condition becomes more serious that most patients seek medical treatment. Later symptoms include vomiting blood and internal hemorrhaging as the backed-up blood causes smaller blood vessels leading to the vein to burst.
Unless discovery of the blockage occurs while scanning a nearby area, it is unlikely that discovery of PVT will occur until it is in an advanced state. Ultra-sonogram, CAT scan or MRI imaging tests detect the presence of PVT. The original cause of the PVT requires further testing to determine.
Major symptoms of bloody vomit or hemorrhaging are most often the first signs of PVT. The first part of treatment is to treat the bleeding. Banding or sclerotherapy procedures shrink blood vessels and stop the bleeding. Patients whose PVT is caused by a damaged liver will eventually need a liver transplant. Anti-clotting medications are effective for minor or recent clots while older blockages require a surgical implantation of a shunt to bypass the blockage.
Splenomegaly: When portal hypertension occurs, the spleen frequently enlarges and holds white blood cells and platelets, reducing the numbers of these cells in the blood. A low platelet count may be the first evidence that a person has developed cirrhosis.
Spontaneous bacterial peritonitis (SBP): Fluid in the abdominal cavity (ascites) is the perfect place for bacteria to grow. Normally, the abdominal cavity contains a very small amount of fluid that is able to resist infection well, and bacteria that enter the abdomen (usually from the intestine) are killed or find their way into the portal vein and to the liver where they are killed. In cirrhosis, the fluid that collects in the abdomen is unable to resist infection normally. In addition, more bacteria find their way from the intestine into the ascites. Therefore, infection within the abdomen and the ascites, referred to as spontaneous bacterial peritonitis or SBP, is likely to occur. SBP is a life- threatening complication. Some patients with SBP have no symptoms, while others have fever, chills, abdominal pain and tenderness, diarrhea and worsening ascites.
Other Problems: Cirrhosis can cause immune system dysfunction, leading to the risk of infection.