CHAPTER 7 Gastrointestinal System^291
portal vein. This causes resistance to blood flow throughout the venous system in
the liver and also backs up venous blood to the spleen, causing enlargement of this
organ also. Damage to the liver may be reversible if the cause if identified early and
removed. The most common causes of cirrhosis include chronic alcohol use, liver
damage secondary to exposure to drugs or toxins, viral hepatitis (especially hepati-
tis B, hepatitis C, and hepatitis D in those already infected with hepatitis B), fatty
liver (steatohepatitis), autoimmune hepatitis, cystic fibrosis, metabolic disorders
(excess iron storage—hemachromatosis), or genetic causes.
PROGNOSIS
As cirrhosis progresses, the patient may develop encephalopathy and coma. Early
signs and symptoms of encephalopathy include altered level of consciousness,
neuromuscular changes, and elevated serum ammonia levels.
HALLMARK SIGNS AND SYMPTOMS
- Initially asymptomatic
- Weakness, fatigue due to chronic disease
- Muscle cramps
- Weight loss
- Anorexia
- Nausea with possible vomiting
- Ascites—the accumulation of fluid within the abdominal cavity due to por-
tal hypertension - Abdominal pain
- Portal hypertension
- Pruritus (itching)
- Ecchymosis (bruises) or petechiae (small, pinpoint, round, reddish purple
marks) - Coagulation defects due to problems with vitamin K absorption, causing
problems with production of clotting factors - Amenorrhea
- Impotence due to inactivity of hormones
- Gynecomastia
- Jaundice due to problems with excretion of bilirubin
- Hepatomegaly (enlarged liver) in over one-half of the patients