Cirrhosis history and symptoms

Liver cirrhosis may present with non specific constitutional symptoms such as fever, anorexia, fatigue, nausea, vomiting, menstrual irregularities and testicular atrophy. Patients with decompensated cirrhosis may develop complications and present with jaundice, increase in abdominal girth due to ascites, pruritus, hematochezia, melena and confusion due to hepatic encephalopathy. Symptoms may also vary depending upon the underlying cause of cirrhosis. A detailed history of alcohol use, blood transfusions, history of viral hepatitis and family history of liver disease must be taken in all patients.

• History of alcohol use:
  • Amount
  • Duration
• History of illicit drug use
• History of unprotected sexual intercourse

• History of infections:^[1]
  • Hepatitis B
  • Hepatitis C
• History of autoimmune disorders:
  • autoimmune hepatitis
  • Crohn’s disease
• History of blood transfusions

• History of menstrual irregularities

• Family history of liver disease:
  • Wilson’s disease
  • hemochromatosis

• History of use of any hepatotoxic drugs

• Initially, the symptoms of liver cirrhosis are very non-specific:^[2][3]
  • Right upper quadrant abdominal pain
  • Fever
  • Anorexia
  • Fatigue and weakness
  • Nausea and vomiting
  • Weight loss
  • Abdominal pain and bloating
  • Menstrual irregularities
  • Symptoms of hypogonadism:
    • Impotence
    • Infertility
    • Testicular atrophy
    • Loss of libido
  • Easy bruisability

• Decompensated cirrhosis may present with^[4]
  • Jaundice
  • Increase in abdominal girth due to ascites
  • Pruritus
  • Signs of upper gastrointestinal bleeding:
    • Hematemesis
    • Hematochezia
    • Melena
  • Symptoms due to hepatic encephalopathy:
    • Altered mental status
    • Confusion
    • Sleep disturbances
  • Muscle cramps due to reduction in effective circulating plasma volume
  • Lower extremity edema

• Symptoms may vary depending on the underlying cause of cirrhosis:
• Primary biliary cirrhosis presents with the following symptoms:
  • Fatigue out of proportion to the severity of the disease
  • Pruritis
    • May be intermittent
    • Increases in the evening
    • May present in the last trimester of pregnancy and may be mis-diagnosed as cholestasis of pregnancy

• Primary sclerosing cholangitis may present with the following in addition to the above symptoms of cirrhosis:
  • Fatigue
  • Pruritis
  • Steatorrhea
  • Abdominal pain, mainly in the right upper quadrant (RUQ)
  • Yellowish discoloration of the skin and mucous membranes (jaundice)
  • Fever
  • Weight loss

• Cardiac cirrhosis presents with symptoms of congestive cardiac failure along with a sensation of fullness and tenderness in the right upper quadrant of the abdomen.
• Features of hemochromatosis:
  • Arthritis
  • Abdominal pain
  • Severe fatigue
  • Heart failure symptoms
  • Bronze-colored skin

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