Symptoms

You are not likely to feel any symptoms of cirrhosis early on. In fact, many people with cirrhosis only find out during tests for an unrelated illness. Additionally, the symptoms can be very non-specific, meaning that they are also caused by other conditions not related to cirrhosis. 

If you have cirrhosis, you may develop one or more of the symptoms below. If you have or are worried about any of these symptoms discuss them with your doctor.  

Early symptoms  

  • generally feeling unwell and tired all the time  
  • loss of appetite  
  • loss of weight and muscle wasting  
  • feeling sick (nausea) and vomiting  
  • tenderness/pain in the liver area  
  • spider-like small blood capillaries on the skin above waist level (spider angiomas)  
  • blotchy red palms  
  • disturbed sleep pattern

Later symptoms, as the liver is struggling to function  

  • intensely itchy skin  
  • yellowing of the whites of the eyes and the skin (jaundice)   
  • white nails  
  • ends of fingers become wider/thicker (clubbed fingers)  
  • hair loss  
  • swelling of the legs, ankles, feet (oedema)  
  • swelling of the abdomen (ascites)  
  • dark urine  
  • pale-coloured stools or very dark/black tarry stools  
  • frequent nosebleeds and bleeding gums  
  • easy bruising and diffi culty in stopping small bleeds  
  • vomiting blood  
  • frequent muscle cramps  
  • right shoulder pain  
  • in men: enlarged breasts and shrunken testes  
  • in women: irregular or lack of menstrual periods  
  • impotence and loss of sexual desire  
  • dizziness and extreme fatigue (anaemia)  
  • shortness of breath  
  • very rapid heartbeat (tachycardia)  
  • fevers with high temperature and shivers  
  • forgetfulness, memory loss, confusion and drowsiness  
  • subtle change in personality  
  • trembling hands  
  • writing becomes difficult, spidery and small  
  • staggering gait when walking; tendency to fall  
  • increased sensitivity to drugs, both medical and recreational  
  • increased sensitivity to alcohol

Red flag symptoms

If you have any of the following symptoms you must see a doctor straight away, especially if you have recently been diagnosed with cirrhosis:

  • fever with high temperatures and shivers, often caused by an infection
  • shortness of breath
  • vomiting blood
  • very dark or black tarry stools (faeces)
  • periods of mental confusion or drowsiness.

Althought these symptoms may seem very different, because your liver is responsible for so many different functions, if it stops working properly, a range of problems can result.

Yellow eyes or skin
If your skin and the whites of your eyes turn yellow you may have jaundice.

Two things can cause jaundice:

  • a blockage (obstruction) in the bile duct
  • damage to your liver or some defect affecting the liver so that it cannot deal with bilirubin, a by-product of the breakdown of old red blood cells.

If either of these occurs, bilirubin – which is yellow – flows back into the blood and shows up in the skin and the eyes.

Swollen stomach and legs
Swelling in your abdomen is known as ascites. The swelling is caused by fluid building up in the lining around your abdomen. This can happen slowly over weeks or months and can be painful, especially if the fluid becomes infected and requires urgent attention.

You may also get swelling in your legs, ankles or feet, known as peripheral oedema.

Fever with high temperatures and shivers
People with cirrhosis are prone to infections, which can make their liver condition worse. As a result, they should seek medical attention if they develop a temperature.

Tarry black stools or vomiting blood
Internal bleeding due to liver damage is often first noticed in very dark or black tarry faeces (maelena) and the vomiting of blood (haematemesis). Having either of these symptoms will need urgent medical attention.

If your liver is badly scarred from extensive fibrosis or cirrhosis, blood will be unable to flow through it easily. As a result, pressure builds up in the vein that carries blood to the liver from the gut – the portal vein.

Having high blood pressure in the portal vein is known as portal hypertension. As the pressure mounts, blood begins to back up. It finds another way of reaching the heart by using extra veins
lining your oesophagus and stomach known as varices. Varices have fragile walls, which cannot easily handle the increased blood flow and often burst, leading to internal bleeding.

This blood loss may just be a gentle ooze, resulting in symptoms of anaemia that include tiredness and shortness of breath, but sometimes there can be major bleeding, with a haemorrhage and vomiting of blood. Haemorrhaging varices are a serious and life-threatening complication of cirrhosis and need emergency medical treatment.

Memory loss and confusion (encephalopathy)  
Confusion, short-term memory problems and even loss of consciousness can result if your liver is not working properly. You might feel sleepy, experience tremors and have diffi culty performing simple tasks. This is because the liver, when working well, gets rid of waste products. When it is damaged, the waste products are carried to the brain by your blood. This condition is known as encephalopathy.