Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abdominal distension
  • jaundice and pruritus
  • coffee-ground vomitus and black stool (melaena)
  • altered mental status
  • hand and nail features (e.g., leukonychia, palmar erythema, spider angiomata)
  • facial features (e.g., telangiectasia, spider angiomata, jaundiced sclera)
  • abdominal features (e.g., collateral circulation, hepatosplenomegaly, distension)

Other diagnostic factors

  • constitutional symptoms
  • lower extremity swelling
  • hepatic fetor
  • muscle wasting
  • peripheral oedema
  • recurrent infections
  • decreased libido
  • chest wall features (e.g., gynaecomastia)
  • dyspnoea
  • chest pain
  • syncope

Risk factors

  • alcohol misuse
  • intravenous drug use
  • unprotected intercourse
  • obesity
  • blood transfusion
  • tattooing

Diagnostic investigations

1st investigations to order

  • liver function tests
  • gamma-glutamyl transferase (GGT)
  • serum albumin
  • serum sodium
  • prothrombin time
  • platelet count
  • antibodies to hepatitis C
  • hepatitis B antigen
Full details

Investigations to consider

  • total iron, TIBC, transferrin saturation, and ferritin
  • ANA
  • antismooth muscle antibody
  • antimitochondrial antibody
  • serum ceruloplasmin
  • plasma alpha-1 antitrypsin
  • serum protein electrophoresis
  • abdominal ultrasound
  • abdominal CT
  • abdominal MRI
  • upper GI endoscopy
  • liver biopsy
  • non-invasive tests of liver elasticity
Full details

Treatment algorithm

ONGOING

Contributors

Authors VIEW ALL

Dean

College of Health Solutions

Arizona State University

Phoenix

AZ

Disclosures

KDL is an unpaid advisor for Intercept Pharmaceuticals and Shire Pharmaceuticals.

Dr Keith D. Lindor would like to gratefully acknowledge Dr Flavia Mendes, a previous contributor to this monograph. FM declares that she has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease

Chicago

IL

Disclosures

NR declares that she has no competing interests.

Clinical Assistant Professor

Division of Gastroenterology Hepatology and Nutrition

University of Florida

Gainesville

FL

Disclosures

CL declares that she has no competing interests.

Consultant Physician

Hon Professor in Medicine

Associate Medical Director NHSBT

Queen Elizabeth Hospital

Birmingham

UK

Disclosures

JN declares that he has no competing interests.

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