Other complications associated with liver cirrhosis

• Osteoporosis - decreased bone mass and density

Cirrhosis interferes with the liver’s ability to produce vitamin D and calcium, which promote bone growth, density and health.

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  Hepatocellular carcinoma - Liver cancer

Cirrhosis increases the risk of developing primary (originates in the liver) liver cancer. A secondary liver cancer is one that originates elsewhere in the body and spreads (metastasizes) to the liver.

The most common symptoms and signs of primary liver cancer are:

• Abdominal pain and swelling
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  Enlarged liver
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  Weight loss
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  Fever

In addition, liver cancers can produce and release a number of substances, including ones that cause:

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  Increased red blood cell count (erythrocytosis)
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  Low blood sugar (hypoglycemia)
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  High blood calcium (hypercalcemia)

• Liver failure

This occurs when damage to the liver becomes so extensive that the liver cannot function.

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  Kidney failure - Hepatorenal syndrome.

Hepatorenal syndrome is the progressive failure of the kidneys to clear substances from the blood and produce adequate amounts of urine even though some other important functions of the kidney, such as retention of salt, are maintained.

Reduced function of the kidneys is the result of the accumulation of toxic substances in the blood when the liver fails. There are two types of hepatorenal syndrome. One type occurs gradually over months. The other occurs rapidly over a week or two.

If liver function improves or a healthy liver is transplanted into a patient with hepatorenal syndrome, the kidneys usually begin to work normally.

• Hypersplenism

The spleen normally acts as a filter to remove older red blood cells, white blood cells, and platelets (small particles that are important for the clotting of blood.). The blood that drains from the spleen joins the blood in the portal vein from the intestines. As the pressure in the portal vein rises in cirrhosis, it increasingly blocks the flow of blood from the spleen. The blood “backs-up” and accumulates in the spleen, and the spleen swells in size, a condition referred to as splenomegaly. Sometimes, the spleen is so swollen that it causes abdominal pain.

As the spleen enlarges, it filters out more and more of the blood cells and platelets until their numbers in the blood are reduced.

Symptoms include:

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  Anemia - low red blood cell count
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  Leucopenia - low white blood cell count
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  Thrombocytopenia - low platelet count

The anemia can cause weakness, the leucopenia can lead to infections, and the thrombocytopenia can impair the clotting of blood and result in prolonged bleeding.

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  Hepatopulmonary syndrome

Rarely, some patients with advanced cirrhosis can develop the hepatopulmonary syndrome.

Symptoms include:

• Shortness of breath, particularly with exertion – due to certain hormones being released which causes the lungs to function abnormally.

The problem is that not enough blood flows through the small blood vessels in the lungs that are in contact with the alveoli (air sacs) of the lungs. Blood flowing through the lungs is shunted around the alveoli and cannot pick up enough oxygen from the air in the alveoli.