# Symptoms and stages of liver cirrhosis
Liver cirrhosis is a progressive disease that usually develops over years. Different complaints and complications occur in the various stages. This tab describes how the disease usually progresses and which symptoms occur in which stage.
Early stage (compensated cirrhosis)
In the early stage, the liver still functions reasonably well, despite the scarring. Many people have few or no complaints in this stage.
**Possible symptoms:**
- Fatigue and lack of energy (most common)
- Mild abdominal pain or discomfort
- Yellowing of skin and eyes (jaundice)
- Dark colored urine
- Pale or pale-red colored hands (red palms)
- Mild swelling of feet or abdomen
- Concentration improvements are more difficult
- Sleep problems
**Meaning for daily life:**
In this stage, many people can continue their normal work and activities, although fatigue can sometimes be a hindrance. Symptoms are usually mild and can easily be overlooked. Some people only become aware of their disease when a doctor discovers abnormalities during examination.
**Figures about this phase: **
Median survival in the early stage is approximately 9-12 years or longer, depending on the underlying cause and how well the cause (such as viral hepatitis or alcohol use) can be limited. These are average figures across large populations — individual differences are substantial and depend on many personal factors.
Progressive stage (precursor to decompensation)
As scarring increases, liver function begins to noticeably decline. People may develop more and more frequent complaints.
**Possible symptoms:**
- Increasing fatigue and muscle weakness
- Food quality changes; many people have decreased appetite
- Severe abdominal swelling (ascites)
- Swelling of legs and ankles
- More obvious weight loss
- Nausea and vomiting
- Vomiting or stool with blood (from enlarged veins)
- Confusion, forgetfulness or sleepiness (hepatic encephalopathy)
- High fever
- Severe itching complaints
**Meaning for daily life:**
In this stage, many people have noticeable limitation in their activities. It can become difficult to work fully, perform household tasks, or cover long distances. Abdominal swelling can make clothing difficult and can put pressure on the lungs and heart. Confusion can make driving and performing complicated tasks unsafe.
**Figures about this phase: **
The transition period from early to progressive varies greatly from person to person. Once someone develops serious complications (such as large amounts of fluid in the abdomen or bleeding from enlarged veins), median survival without treatment (including transplantation) is around 1-2 years. These are population-level figures — with good medical care and support this can vary.
Decompensated stage (serious complications)
This is the most serious stage. The liver can no longer perform its important tasks properly, resulting in serious complications.
**Possible symptoms:**
- Severe abdominal swelling (ascites) that reduces appetite
- Persistent confusion and disorientation
- Violence in behavior or restlessness
- Sleep patterns that are reversed (awake at night, sleepy during day)
- Tremors (shaking) in the hands
- Severe anemia (paleness, shortness of breath)
- Frequent infections (abdominal inflammation, urinary tract infections, pneumonia)
- Kidney failure with reduced urine production
- High fever and chills
- Spontaneous bleeding from nasal cavities or gums
- Severe jaundice
- Cold extremities despite warm room
- Persistent diarrhea
**Meaning for daily life:**
In this phase, independent activity is no longer possible for most people. Washing, dressing, eating and using the toilet usually require help. Concentration is severely reduced. Hospital admission is much more frequently needed. The physical and mental burden on caregivers can be considerable.
**Figures about this phase: **
Without transplantation or intensive treatment, median survival in the decompensated phase is months to a few years, depending on which complications occur. Median survival after varices (severe bleeding from enlarged veins) is, for example, approximately 6 months if the first bleeding episode is severe. After development of hepatic encephalopathy (confusion due to toxic substances reaching the brain), median survival without transplantation is approximately 1-2 years. These figures are averages across large groups of patients — individuals can live much longer or shorter, and modern medical care can significantly alter the course. Liver donation (transplantation) can result in much longer survival for suitable candidates.
Specific preventable complications per phase
Bleeding from enlarged veins (varices)
As cirrhosis progresses, veins in the esophagus and stomach become larger and fragile. These can rupture suddenly.
**Symptoms:**
- Blood loss through vomiting (blood or coffee ground-like content)
- Tarry, dark stools
- Sudden weakness and dizziness
- Fainting
- Rapid heartbeat
This is a medical emergency.
Fluid in the abdomen (ascites)
This occurs because the damaged liver does not produce enough certain proteins, and because blood circulation in and around the liver is disrupted.
**Symptoms:**
- Swollen abdomen, sometimes very distended
- Feeling of fullness, especially when eating
- Shortness of breath (due to pressure on lungs)
- Abdominal discomfort or pain
- Difficulty with movement
- Weight gain despite poor appetite
Liver encephalopathy (hepatic encephalopathy)
Toxic substances (especially ammonia) reach the brain via the blood because the liver no longer filters these out of the blood properly.
**Symptoms:**
- Confusion and disorientation
- Daytime drowsiness
- Lying awake at night
- Forgetfulness
- Slower thinking and speech
- Mood swings
- Tremors (trembling of hands)
- In severe form: unconsciousness
Kidney problems (hepatic renal failure)
The damaged liver disrupts blood supply to the kidneys.
**Symptoms:**
- Reduced urine production
- Swelling of feet and legs
- Nausea
- Fatigue
- In severe form: confusion
Infections (spontaneous bacterial peritonitis)
Bacteria can enter the fluid in the abdomen.
**Symptoms:**
- Sudden abdominal pain
- Fever
- Nausea and vomiting
- Worsened confusion
This requires immediate hospital admission.
When to contact your healthcare provider?
It is important to contact your doctor directly or go to the emergency room if you experience one or more of the following:
- **Blood loss through vomiting, stools or nosebleed**
- **Sudden severe abdominal pain**
- **Fever above 38.5 °C**
- **Severe confusion, disorientation or unconsciousness**
- **Rapid breathing or severe shortness of breath**
- **High heart rate with dizziness or fainting**
- **Very dark-colored urine or very pale-colored stool**
- **Sudden increase in abdominal swelling within hours**
- **Severe abdominal pain accompanied by fever and confusion at the same time**
Even if you don't have any of the above symptoms, regular contact with your healthcare provider is important. If you notice that your fatigue is increasing, your appetite is decreasing significantly, you feel nauseous more often or your swelling is increasing, this deserves discussion with your doctor.
_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._