9 End-stage Liver Disease Symtpoms Before Death.

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In patients with liver cirrhosis and end-stage liver disease, approximately 57% of them die due to liver-related causes (reference).

End-stage liver disease symptoms before death include deepening of jaundice, disturbed level of consciousness, dark stools, vomiting of blood, and worsening of abdominal distension.

The leading causes of death in people with liver cirrhosis are (reference):

Liver-related causes of death (57%):

  • Acute liver failure on top of liver cirrhosis (24%).
  • Bleeding varices (14%).
  • Acute liver failure together with bleeding varices (13%).
  • Primary liver cell cancer (4%).
  • Other liver-related diseases (2%).


Non-liver causes of death (43%):

  • Cardiovascular diseases (22%).
  • Non-liver cancers (9%).
  • Infection (7%).
  • Other non-liver related causes (5%)

I am Dr. Farhat, and today, you will learn the most common symptoms of end-stage liver diseases before death:

1 . Worsening of Jaundice.

Jaundice is a yellow discoloration of the skin and mucus membrane. Jaundice is commonly present in people with liver cirrhosis but often mild.

The degree of jaundice reflects the stage of liver disease. The deeper jaundice, the closer the liver disease to the end-stage and death.

Worsening jaundice is one of the main symptoms of end-stage liver diseases just before death as it is one of the main symptoms of acute on top of chronic liver failure.

Causes of worsening jaundice due:

  • Infections such as spontaneous bacterial peritonitis (infections of the ascites).
  • Alochol intake.
  • Reactivation of hepatitis B or C virus.
  • New infection with acute hepatitis A or hepatitis E.
  • Medication-induced liver injury.
  • Advanced liver cancer.
  • Decreased blood supply to the liver as with bleeding varices and hypotension.
  • About 40-50% don’t have apparent causes of liver function deterioration (reference).

Symptoms of worsening jaundice:

  • Deepening of the yellowish discoloration of the skin and eye whites.
  • Dark or tea-colored urine.
  • Clay or pale-colored stool.
  • Sometimes, itching.
  • Symptoms of the causes include fever (infection), liver pain (due to liver cancer), etc.

Jaundice is measured by a blood test called (serum bilirubin).

2. Worsening of ascites (abdominal distension).

Liver cirrhosis often leads to the accumulation of fluid in your body. Predominantly the abdomen (ascites) and the lower limbs (edema of the lower limbs).

Typically, the ascites are controlled in patients with liver cirrhosis who are on treatment. The most effective ascites treatments are medications called (diuretics) and salt restriction.

In end-stage liver disease, Ascites may worsen and become non-respondent to treatment. As a result, the abdominal distension becomes more and more.

In the terminal stages of liver disease, The ascites become more aggressive. In addition, it may cause pressure on the lungs and diaphragm, leading to shortness of breath.

Unfortunately, Increasing the dose of diuretic medications has its drawbacks, such as:

  • Precipitation of hepatic coma.
  • Electrolyte disturbances (low sodium, calcium, and magnesium).
  • The affection of the kidney function.

Resistant or refractory ascites are one of the end-stage liver disease symptoms before death.

3. Confusion or loss of consciousness (Hepatic encephalopathy).

Patients with End-stage liver cirrhosis eventually progress to a condition called hepatic encephalopathy.

Hepatic encephalopathy or coma is a group of neuropsychiatric symptoms that develop due to the deterioration of liver function.

They can range from mild symptoms such as mild confusion to a deep coma.

Hepatic encephalopathy may occur with liver cirrhosis, and people often recover from it with adequate treatment.

In addition, new-onset hepatic encephalopathy can be a symptom of end-stage liver disease before death.

More than 50% of patients with hepatic encephalopathy and liver cirrhosis will die within a year after the first coma attack (reference).

4. Black stools and vomiting of blood.

The liver receives blood from the gut tract, including the esophagus, stomach, and intestines.

Cirrhosis of the liver makes it harder for the liver to receive blood from the vessels supplying the walls of the esophagus and the stomach.

As a result, the pressure inside these vessels progressively increases, leading to dilation.

Eventually, these vessels often rupture and cause bleeding inside the esophagus and the stomach. The blood is either vomited (hematemesis) or passes with stool as a black or tarry substance (melena).

Hematemesis and melena are some of the symptoms of end-stage liver disease.

A significant portion of people dies after hematemesis or melena’s first attack due to end-stage liver disease. One study estimated that 24% of patients die within six weeks of the first attack of hematemesis and melena.

So, bleeding varices are common symptoms of end-stage liver disease before death.

5. Lost appetite, nausea, or vomiting.

In the very advanced stages of end-stage liver disease, patients may completely stop eating too little amounts.

Also, constant nausea and repeated vomiting are frequent end-stage liver symptoms before death.

Consult your doctor if you have a relative with liver cirrhosis that developed a complete loss of appetite and decreased intake.

These gastrointestinal symptoms often occur together with other signs of liver deterioration, such as worsening jaundice and ascites.

Anorexia and vomiting are often a reflection of advanced liver complications such as:

  • Acute on top chronic of liver failure.
  • Hepatic coma.
  • Infections.
  • Advancement of liver cancer into a late stage.
  • Deterioration of the liver function due to any other causes.

7. Extreme muscle wasting and weakness.

Patients can live with liver cirrhosis for years. However, In the late stages of liver disease, the muscle mass and muscle power significantly decrease.

The degree of muscle wasting often reflects the severity of liver disease.

Before death, patients with end-stage liver disease experience profound muscle wasting (thin arms, cachectic-looking face, and prominent ribs).

Muscle wasting results in extreme weakness and fatigue. Patients with the end-stage liver disease before death are often unable to perform daily activities.

8. Fever.

Fever in a patient with liver cirrhosis often indicates infection. In patients with end-stage liver disease, infections can be lethal due to impaired immunity.

Common infections in patients with end-stage liver disease include:

  • Infection of the ascites fluid (spontaneous bacterial peritonitis).
  • Urinary tract infections.
  • Chest infections (pneumonia).

This infection is significantly severe among people with end-stage liver disease. The fever can be the only symptom of such infections.

Infections account for 7% of deaths in patients with end-stage liver disease. So, fever in a cirrhotic patient should be medically evaluated and managed as soon as possible.

9. Symptoms of low blood pressure (shock).

One of the leading causes of death in a patient with end-stage liver disease is shock (low blood pressure).

Shock is a complication of many conditions, especially:

  • Gastrointestinal bleeding (hematemesis and melena).
  • Severe infection (septic shock).
  • Severe malnutrition and lack of oral intake (hypovolemic shock).

Symptoms of shock include:

  • Dizziness and fainting.
  • Shortness of breath.
  • Fast heartbeats.
  • Rapid breathing.
  • Nausea and vomiting.
  • Extreme weakness.
  • Cold, clammy skin and extremities.
  • Severe shock often leads to confusion or coma.

A doctor or a nurse quickly

diagnoses shock by assessing the pulse and meaning the blood pressure (usually shallow).

Symptoms of shock indicate imminent death in patients with end-stage liver disease.

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