Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • advanced cirrhosis
  • jaundice
  • ascites

Other diagnostic factors

  • moderate lowering of BP
  • peripheral edema
  • hepatosplenomegaly
  • spider angioma
  • oliguria
  • bruising
  • petechiae
  • palmar erythema
  • scratch marks
  • gynecomastia
  • encephalopathy
  • pruritus
  • confusion
  • drowsiness

Risk factors

  • advanced cirrhosis
  • ascites
  • alcoholic hepatitis
  • acute liver failure
  • hyponatremia
  • high plasma renin activity (PRA)
  • spontaneous bacterial peritonitis
  • large volume paracentesis
  • GI bleeding

Diagnostic investigations

1st investigations to order

  • creatinine
  • BUN
  • electrolytes
  • CBC
  • LFTs
  • coagulation study
  • diagnostic paracentesis and culture of ascitic fluid
  • blood culture
  • urinalysis and culture
  • CXR
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

John Kepros

Associate Professor of Surgery

Michigan State University

Lansing

MI

Disclosures

JK declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine and Cell Biology

Columbia University College of Physicians and Surgeons

New York

NY

Disclosures

HJW declares that he has no competing interests.

Professor of Medicine

University of Connecticut Health Center

Farmington

CT

Disclosures

GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.

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