Liver disease comes in many forms and in varying severity. Chronic heavy alcohol use can lead to cirrhosis, which occurs when the liver becomes nodular and is replaced by scar tissue, leading to a decline in its abilities to perform its usual functions. Cirrhosis can be relatively subtle for a number of years, or may cause a number of symptoms that are easy to identify (especially in an advanced state). Small blood vessel collections may pop up on the skin (typically the upper torso) called spider angiomata. The breasts may become enlarged and the palms may become red due to decreased metabolism of estrogen. In later stages, cirrhotic patients will have elevated bilirubin levels in their blood, which will cause their skin to appear more yellow. This same process may also cause the urine to appear dark and stool to appear pale. As the liver's ability to filter blood decreases, pressure may also build up behind the liver in the portal vein. This "portal hypertension" can cause leakage of fluid into the abdominal cavity (ascites), an enlarged spleen, and predisposes to dangerous bleeding
from dilated veins in other parts of the body (such as the esophagus). A decrease in the liver's ability to detoxify the blood often causes difficulty with cognition, sleep/wake cycles, and in an advanced state, causing a flapping of the hands when the arms are held out straight (called asterixis).