Typical symptoms of the final stage

Cirrhosis of the liver is a complex disease that affects various organ systems in its course and can cause symptoms in all parts of the body. Typical abnormalities of liver cirrhosis include

Fatigue, performance slump, susceptibility to infections, feeling ill
Feeling of pressure and fullness in the upper abdomen, loss of appetite, vomiting
Digestive problems, fatty stools, decolorization of the stool
Itching, yellowing of the skin, rashes
Varnished lips, dilated blood vessels under the skin, thin and cracked skin
Venous dilatation, for example on the abdomen, rectum, esophagus
Severe insatiable bleeding, for example in the esophagus
Lack of red and white blood cells and platelets
Water retention on the entire body, for example as abdominal fluid
Confusion, difficulty concentrating, loss of consciousness and coma
Hormone disorders with breast growth, hair loss, potency or cycle disorders

The so-called “abdominal fluid” is called “ascites” in the technical language and is a very typical symptom of liver cirrhosis. Such water retention occurs mainly when there is increased pressure in blood vessels or a deficiency of a certain protein in the blood (albumin).

The latter leads to less fluid being bound in the blood and more easily passing through the vessel walls into the surrounding tissue. In the case of end-stage liver cirrhosis, the albumin deficiency is the very thing that leads to several liters of fluid being stored in the abdomen. In the body, the water retention can lead to considerable fluctuations and disturbances of the electrolyte balance with subsequent complaints of the brain or heart.Therapeutically, the abdominal fluid can be punctured with a needle and drained.

However, this should only be done carefully, as it can lead to rapid new water retention with a considerable lack of fluid in the rest of the body. An important therapeutic measure is to increase the albumin levels in the blood. Vomiting can be caused in several ways in end-stage liver cirrhosis.

On the one hand, the reduced production and release of bile acid disrupts all digestive processes, resulting in diarrhea, nausea, vomiting and a feeling of fullness in the stomach. The disturbed detoxification function of the liver can also lead to nausea and vomiting through various processes. Important toxic substances that increase in the blood in cirrhosis of the liver and cause symptoms are ammonia and bilirubin.

In addition to the causes in the gastrointestinal tract, vomiting is also a common neurological symptom that is caused at certain centers in the brain. In the long term, various organs involved in cirrhosis of the liver can trigger vomiting. Life-threatening, on the other hand, is the vomiting of blood when there is a potential bleeding of veins in the esophagus.

Diarrhea and other digestive problems are a typical symptom of advanced liver cirrhosis. Diarrhea is closely related to a performance kink, the typical fatigue, loss of appetite and fatty stools that can occur in liver cirrhosis. This is mainly due to a disorder in the production of bile acids.

Bile acids are produced in the liver and are transported via the bile ducts into the small intestine, where they perform important digestive functions. They are mainly responsible for splitting fats and fatty foods and binding them so that they can be digested and absorbed by the intestinal mucosa. With a severe loss of liver function, fatty foods can be digested more poorly, making the stool more voluminous, liquid and fatty.

In the long term, further secondary symptoms such as a nutrient deficiency can result. In the long term, lung function can also be reduced in several ways in cases of severely advanced liver cirrhosis. On the one hand, large accumulations of abdominal fluid can lead to high pressure on the lungs; on the other hand, in the final stage, severe infections in the lungs can cause breathing difficulties.

In the long term, however, liver cirrhosis can also lead to a so-called “hepatopulmonary syndrome”, in which the pulmonary vessels are dilated and damaged as a direct consequence of the liver cirrhosis. High blood pressure of the pulmonary vessels causes breathing difficulties and severe lung damage, which often necessitates a lung transplantation in the further course of the disease. Bleeding is one of the greatest risks and a frequent cause of death in severe liver cirrhosis.

Due to the increased pressure in numerous blood vessels of the gastrointestinal tract, so-called “bypass circuits” from sections of the intestine to the heart with bypass of the liver form over the long term in the course of the disease. This results in dangerous dilatations of numerous veins, which can be seen, for example, along the navel or are dangerous dilatations of the oesophagus (varices). Due to the additionally strongly restricted blood clotting, heavy and insatiable bleeding can occur.

Cirrhosis of the liver can lead to considerable deficiencies in the coagulation factors produced by the liver. However, the blood platelets, which play an important role in blood coagulation, are also reduced as an indirect consequence of liver cirrhosis. If bleeding from the so-called “esophageal varices” or other vessels of the body occurs, the body is often not able to stop it on its own.

Surgical interventions to stop the bleeding are often necessary. Confusion in the context of liver cirrhosis is due to a so-called “hepatic encephalopathy”, a functional impairment of the brain. Encephalopathy is caused by toxic substances such as ammonia or bilirubin, which accumulate in the blood because the liver can no longer perform its filtering function.

Often the filtering capacity of preserved liver tissue can be compensated. If, however, increased amounts of toxic substances occur, for example due to infections or bleeding in the intestine, the neurological symptoms can become acute. The appearance of confusion indicates a considerably advanced stage of liver cirrhosis.Furthermore, sensitive and motoric complaints, as well as disturbances of consciousness in case of advanced damage to the brain can be added.

A life-threatening coma represents the maximum variant of neurological symptoms. Neurological involvement in severe liver cirrhosis is a dreaded complication and an important indication of a very advanced stage of the disease. This is mainly caused by the restriction of the filter function of toxic metabolic products.

In the foreground is the metabolism and excretion of ammonia, which is produced in the body. This can accumulate in cirrhosis of the liver and lead to mood swings, fatigue, confusion, concentration difficulties and impaired consciousness in the brain. In addition, there is trembling of the hands (tremor), as well as motor insecurities, which can be detected in a writing sample, for example.

A further increase in ammonia concentrations and other toxic metabolites can initially lead to drowsiness and then to coma. Kidney failure is a possible life-threatening complication of liver cirrhosis in late stages. The exact mechanisms leading to kidney involvement are not definitively known.

However, a combination of the typical medications used for detoxification in liver cirrhosis, as well as severe water loss, water retention or acute bleeding, can promote a reaction of the kidney. This leads to kidney failure due to reduced blood flow. This results in a reduced excretion rate of the kidney with life-threatening fluctuations in the electrolyte balance of the body.