The early stages of cirrhosis often produce no symptoms. As scar tissue replaces healthy cells, the liver begins to fail, and symptoms may become evident. The severity of symptoms depends on the extent of liver damage.

Because the liver is crucial for so many metabolic activities, cirrhosis impacts a wide range of the body’s functions, including nutrient and hormone metabolism, blood clotting, and processing of ammonia and other toxic wastes. Many of the symptoms of cirrhosis are directly related to disruption of these functions. However, most of these symptoms can also be caused by other conditions, so it is important to consult with your doctor if you experience any of these symptoms, particularly if you have risk factors that increase your likelihood of developing cirrhosis.

Early symptoms of cirrhosis include:

• Fatigue and weakness
• Poor appetite
• Nausea
• Weight loss
• Small, red spider-like blood vessels under the skin—caused by increased pressure in the tiny blood vessels due to liver congestion
• Increased sensitivity to drugs

Early symptoms in men may include:

• Impotence
• Reduced testicle size
• Enlarged, tender breasts
• Loss of interest in sex

Symptoms become more pronounced as cirrhosis progresses. In addition, complications may produce other, potentially life-threatening symptoms of the disease. Later symptoms, some of which are due to complications, include:

• Reddened or blotchy palms
• Loss of body hair
• Sleep disturbances
• Ulcers
• Fever and other signs of infection—due to altered immune function
• Pale or clay-colored stools—caused by a reduction in excreted bile pigments
• Frequent nosebleeds, skin bruising, or bleeding gums—resulting from decreased liver synthesis of clotting factors
• Ascites —water retention and swelling abdomen caused by obstructed blood flow through the liver and reduced synthesis of the protein albumin
• Bacterial peritonitis—infection of ascites causing abdominal pain and fever
• Itching—caused by deposition of bile products in the skin
• Jaundice —yellowing of the skin or eyes due to build-up bilirubin
• Vomiting blood—due to swollen veins in the esophagus that burst
• Encephalopathy and coma—mental changes, including forgetfulness, trouble concentrating, confusion, and agitation, caused by the build-up of ammonia in the blood
• Decreased urine output and dark urine—caused by kidney dysfunction or failure

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