Cirrhosis Symptoms and Signs
With obstruction to bile flow, jaundice, pruritus, and xanthelasma become prominent features. Malnutrition is common secondary to anorexia, fat malabsorption, and fat-soluble vitamin deficiency due to the effects of reduced bile-salt excretion. A more dramatic presentation is massive upper GI bleeding from esophageal varices secondary to portal hypertension. The initial presentation may occasionally be that of hepatocellular failure with ascites or portal-systemic encephalopathy.
A palpable, firm, liver with a blunt edge is typical, but at times the liver is small and difficult to palpate. Cirrhotic nodules are only occasionally palpable. Ascites may be present with portal hypertension and splenomegaly, and a collateral venous circulation is evident. Other clinical signs may suggest chronic liver disease, but none is specific: muscle wasting, palmar erythema, Dupuytren’s palmar contractures, vascular vascular spiders (< 10 may be normal), gynecomastia, parotid gland enlargement, hair loss, testicular atrophy, and peripheral neuropathy.