Liver Cirrhrosis  following signs and symptoms may occur in the presence of cirrhosis or as a result of the complications of cirrhosis. Many are nonspecific and may occur in other diseases and do not necessarily point to cirrhosis. Likewise, the absence of any does not rule out the possibility of cirrhosis.

1. Spider angiomata or spider nevi. Vascular lesions consisting of central arteriole surrounded by many smaller vessels due to an increase in estradiol.

2. Palmar erythema. Exaggerations of normal speckled mottling of the palm, due to altered sex hormone metabolism.

3. Muehrcke's nails - paired horizontal bands separated by normal color due to   hypoalbuminemia

4. Terry's nails - proximal two thirds of the nail plate appears white with distal one-third red, also due to hypoalbuminemia

5. Clubbing - Angle between the nail plate and proximal nail fold > 180 degrees

6. Hypertrophic osteoarthropathy. Chronic proliferative periostitis of the long bones that can cause considerable pain.

7. Dupuytren's contracture. Thickening and shortening of palmar fascia that leads to flexion deformities of the fingers. Thought to be due to fibroblastic proliferation and disorderly collagen deposition. It is relatively common (33% of patients).

8. Gynecomastia. Benign proliferation of glandular tissue of male breasts presenting with a rubbery or firm mass extending concentrically from the nipples. This is due to increased estradiol and can occur up to 66% of patients.

9  Liiver size. Can be enlarged, normal, or shrunken.

10. Splenomegaly. Due to congestion of the red pulp as a result of portal hypertension.

11. Hypogonadism. Manifested as impotence, infertility, loss of sexual drive, and testicular atrophy due to primary gonadal injury or suppression of hypothalamic or pituitary function.

12. Splenomegaly. Due to congestion of the red pulp as a result of portal hypertension.

13. Ascites. Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs about 1500 mL to detect flank dullness).

14.Caput medusa. In portal hypertension, the umbilical vein may open. Blood from the portal venous system may be shunted through the periumbilical veins into the umbilical vein and ultimately to the abdominal wall veins, manifesting as caput medusa.

15.Cruveilhier-Baumgarten murmur. Venous hum heard in epigastric region due to collateral connections between portal system and the remnant of the umbilical vein in portal hypertension.

Fetor hepaticus Sweet pungent smell in breath due to increased dimethyl sulfide due to severe portal-systemic shunting.

16. Jaundice. Yellow discoloring of the skin, eye, and mucus membranes due to increased bilirubin (at least 2-3 mg/dL or 30 mmol/L). Urine may also appear dark.

17.Asterixis. Bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in patients with hepatic encephalopathy.

18.Other. Weakness, fatigue, anorexia, weight loss.

Complications-

As the disease progresses, complications may develop. In some people, these may be the first signs of the disease.

1. Bruising and bleeding due to decreased production of coagulation Jaundice due to decreased processing of bilirubin.

2. Itching(pruritus) due to bile products deposited in the skin.

Hepatic encephalopathy- the liver does not clear ammonia and related nitrogenous substances from the blood, which are carried to the brain, affecting cerebral functioning: neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.

Sensitivity to medication due to decreased metabolism of the active compounds.

3. Hepatocellular carcinoma is primary liver cancer, a frequent complication of cirrhosis. It has a high mortality rate.

4. Portal hypertension- blood normally carried from the intestines and spleen through the portal vein flows more slowly and the pressure increases; this leads to the following complications:

5. Ascites - fluid leaks through the vasculature into the abdominal cavity.

Problems in other organs.

1. Cirrhosis can cause immune system dysfunction, leading to . Signs and symptoms of infection may be aspecific are more difficult to recognize (e.g. worsening encephalopathy but no fever).

2. Fluid in the abdomen (ascites) may become infected with bacteria normally present in the intestines (spontaneous bacterial peritonitis).

3. Hepatorenal syndrome - insufficient blood supply to the kidneys, causing acute renal failure.This complication has a very high mortality (over 50%).

4. Hepatopulmonary syndrome- blood bypassing the normal lung circulation (shunting), leading to cyanosis and dyspnea (shortness of breath), characteristically worse on sitting up.

5. Portopulmonary hypertension - increased blood pressure over the lungs as a consequence of portal hypertension 

Remedies-

1. Dolichos pruriens [Dolichos] 

Chief indication for chronic cholestatic hepatitis, activity of third degree, with progressive development and hepatocellular insufficiency of second degree, with transformation into cirrhosis of liver. Syndrome of portal hypertension of first degree. Syndrome of cholestasis with intensive constant itch of skin.

The basic symptoms are:

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  The intensive, unbearable, "terrible" itch of skin which is especially worse in evening at 9 p.m. and nights hours.
  
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  The great general weakness.
  
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  The intensive pains in both hypochondriac regions, tearing, dull, burning: "As if from the nettle". The dull pain under the angle of right scapula: "As if there the abscess under the skin". This pain is more intensive under the scapula rather than in right hypochondrium. This pain is extending, "shooting" trough the right hypochondrium to the back and right scapula.
  
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  The constant yellow colour of the eyes.
  
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  The massive deposits of cholesterine around the eye lids - the so called "ksanthoma", of yellow colour.
  
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  The bitterness in the mouth, during all the day.
  
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  Stool constipated. Stool of white colour, resembling white clay.
  
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  The intensive thirst for drinks 
  

2. Carduus Marianus [Carduus mar] 

The chief action of this drug is centered in the liver, and portal system, causing soreness, pain, jaundice. Has specific relation to the vascular system. Especially indicated in individuals with abuse of alcoholic beverages, especially beer. Pain in region of liver especially Left lobe very sensitive. Fullness and soreness, with moist skin. Constipation; stools hard, difficult, knotty; alternates with diarrhœa. Hyperæmia of liver, with jaundice. One of the chief remedies for Cirrhosis of liver.

3. Magnesium Muriaticum [Mag mur]

Mag mur is chiefly a liver remedy with pronounced characteristic constipation. It has chronic liver affections like cirrhosis with tenderness and pain, extending to spine and epigastrium ad the pain is worse after food. Pressing pain in liver; worse lying on right side. Liver is enlarged with bloating of abdomen; yellow tongue.

4. Ptelea Trifoliata [Ptelea]  

Is a remarkable remedy in stomach and liver affections. The aching and heaviness in the region of the liver is greatly aggravated by lying on the left side. Liver sore, swollen, sensitive to pressure. Indicated in end stages of cirrhosis.

5. Nux Vomica [Nux vom]

In liver affections occurring in those who have indulged to excess in alcoholic liquors, highly seasoned food, quinine, or in those who have abused themselves with purgatives, Nux is the first remedy to be thought of. The liver is swollen hard and sensitive to the touch and pressure of clothing is uncomfortable. The first remedy in cirrhosis of the liver. Colic may be present. In the enlarged liver of drunkards, Sulphur, Lachesis, Fluoric acid, Arsenic and Ammonium muriaticum must also be borne in mind, together with Nux.

6. Lycopodium. [Lyc]
Lycopodium acts powerfully on the liver. The region of the liver is sensitive to the touch, and there is a feeling of tension in it, a feeling as if a cord were tied about the waist. Cirrhosis of liver. The pains are dull and aching instead of sharp and lancinating, as under Chelidonium. Fullness in the stomach after eating a small quantity. There are no real icteric symptoms, but there is a peculiar sallow complexion.

7. Chelidonium Majus [Chel]
The liver symptoms of Chelidonium are very prominent. There is soreness and stitching pains in the region of the liver, but the keynote for this drug in hepatic diseases is a pain under the angle of the right shoulder blade, which may extend to the chest, stomach, or hypochondrium; there is swelling of the liver, chilliness, fever, jaundice, yellow coated tongue, bitter taste and a craving for acids and sour things, such as pickles and vinegar. The stools are profuse, bright yellow and diarrhoea; they may be clayey in color. Taken altogether, Chelidonium is perhaps our greatest liver remedy; it causes the liver to secrete thinner and more profuse bile than any remedy; it is a useful remedy to promote the expulsion of gall stones, and to prevent their formation. It affects the left lobe of the liver much less than does Carduus marianus. 

 Remedies For Cirrhosis of Liver are-

Apoc., Ars., Ars. iod., Aur. m., Aur. mur., Calc. ars.,Cascara sag., Cinch., Fel tauri, Fluor. ac., Graph., Hydr., Iod., Kali bich., Kali iod.,  Merc. d., Merc., Nasturt. ag., Nat. chlor., Nit. ac., Nit. mur. ac.,  Phos., Plumb., Pod., Quass., Senec.

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