Liver failure may lead to impaired mental function with psychiatric, behavioral and neurological changes. The latter include muscle rigidity, muscle twitches, tremor (liver flap) and abnormal reflexes. The person experiences changes in personality and mood, becomes irritable and is unable to think rationally. Drowsiness, confusion and coma occur. Hepatic encephalopathy may come on suddenly (acute) or may develop over time. It has a high mortality and hospital admission is necessary.
Ascites is an abnormal accumulation of fluid in the abdominal cavity. It causes abdominal discomfort, anorexia and malaise and, when excessive (gross ascites) difficulty in breathing and moving around. The fluid can be drained away by insertion of a tube into the abdominal cavity (paracentesis) and controlled by diuretic medication.
Abnormal bilirubin metabolism leads to accumulation of yellow pigments in the skin causing intractable itching, fatigue, anorexia, weight loss etc.
Portal hypertension and oesophageal varices
The portal vein drains blood from the intestine, spleen, pancreas and gall bladder to the liver where the products of digestion are processed in the liver cells. Portal hypertension is the term used to describe increased blood pressure within the portal venous system. In the UK the commonest cause of portal hypertension is resistant to blood flow caused by scarring of the liver tissue, as in cirrhosis.
The increased pressure leads to dilatation and engorgement of the veins in the portal system. Those located in the lower oesophagus and upper stomach (oesophageal and gastric varices) may bleed spontaneously causing severe, and potentially fatal, haemorrhage.
Portal hypertension also causes enlargement of the spleen and contributes to ascites.
Other complications of liver failure are: - increased susceptibility to infection, low blood sugar, peritonitis, associated renal failure, bleeding tendencies.