Merck Manual...say whhaaaatt??

[pugdaddy]

Here is a page from the Merck Manual:

http://www.merckmanuals.com/professional/hepatic_and_biliary_disorders/fibrosis_and_cirrhosis/cirrhosis.html

Immediately below is an excerpted statement that I frankly found surprising.  Any comments or feedback are welcomed - thank you!!

PD


Quoting the Merck Manual:  
"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's contracture, spider angiomas (< 10 may be normal), gynecomastia, axillary hair loss, testicular atrophy, and peripheral neuropathy."

** emphasis added.  
This statement seems to suggest that one could be presenting with any or all of these symptoms - and yet still not be cirrhotic.  Presumably it's saying that F3 status...a seriously damaged/fibrotic liver that's not yet cirrhotic...could present with any or all of these symptoms.  

My question (to anyone on the forum):

Do you know this (above) to be an accurate statement?  
Has anyone had such an experience verified by - or such a statement made by - their hepatologist?
Do you have a differing interpretation... and/or remarks?

Many thanks! PD

[HectorSF]

"Do you know this (above) to be an accurate statement? "
"Has anyone had such an experience verified by - or such a statement made by - their hepatologist? "
There is nothing new or mysterious stated in the Merck manual. This has been known about decompensated cirrhosis and end-stage liver disease for decades now.

People can have any one of these symptoms for other reasons than cirrhosis. Most symptoms or complications can be caused my more than one condition. That is true about all medical condition at least under further study is done.

For example, "muscle wasting", can be caused by anorexia due to physiological issues. It can also occur with end-stage liver disease when it is difficult for the patient to digest food. Also the liver which normally processes nutrients is too damaged to process proteins, carbohydrates and fats, vitamins and minerals. That is why a patient with end-stage liver disease is only skin and bones (looks like someone who is staved or a concentration camp survivor) when there MELD gets into the upper 30s.

Not every one with DECOMPENSATED cirrhosis/ESLD (when the liver is no long able to preform all liver functions) (NOT compensated cirrhosis when the liver is still fully working) has all of these complications for cirrhosis but normally they will have many of them. The first indication of decompensation in most people is ascites (a potentially fatal complication) not the stigmata mentioned above that can be managed and it not life-threatening like many complications of advanced cirrhosis. (Bleeding varices and hepatic encephalopathy).

Muscle wasting, palmar erythema, parotid gland enlargement, white nails, clubbing, Dupuytren's contracture, spider angiomas (< 10 may be normal), gynecomastia, axillary hair loss, testicular atrophy, and peripheral neuropathy." Are signs of advanced decompensated cirrhosis and end-stage liver disease and occur as a patient will die without a transplant in the not too distant future.

F3 is NOT cirrhosis, so of course a person can't have these complications of cirrhosis when there is no cirrhosis (F4). One following the other. Cause of liver damage, fibrosis, cirrhosis, high risk of liver cancer, decompensated cirrhosis, end-stage liver disease, transplant or death. Even people with compensated cirrhosis can be asymptomatic and have no symptoms or complications for cirrhosis. It is only when a person has cirrhosis and portal hypertension that a person's liver can decompensate and then have the symptoms and complications of decompensated cirrhosis.

Hector

[pugdaddy]

Thanks Hector - and I'm also sending you a PM.