hepatic and biliary disorders
Cirrhosis
Symptoms and Signs of Cirrhosis
Cirrhosis may be asymptomatic for years as long as it is compensated. Often, the first symptoms are nonspecific; they include generalized fatigue (due to cytokine release), anorexia, malaise, and weight loss (see table). The liver is typically palpable and firm, with a blunt edge, but is sometimes small and difficult to palpate. Nodules usually are not palpable. Clinical signs that suggest a chronic liver disorder or chronic alcohol use but are not specific for cirrhosis include muscle wasting, palmar erythema, parotid gland enlargement, white nails, clubbing, Dupuytren contracture, spider angiomas, gynecomastia, axillary hair loss, testicular atrophy, and peripheral neuropathy. Once any complication of cirrhosis develops, additional decompensation (characterized by gastrointestinal bleeding, ascites, or hepatic encephalopathy) is much more likely. 