When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Cirrhosis

Last reviewed: 29 Nov 2024
Last updated: 18 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal distension
  • jaundice and pruritus
  • blood in vomit (hematemesis) and black stool (melena)
  • hand and nail features (e.g., leukonychia, palmar erythema, spider nevi)
  • facial features, e.g., telangiectasia, spider nevi, jaundiced sclera
  • abdominal features (e.g., collateral circulation, hepatosplenomegaly, distension)
  • altered mental status
Full details

Other diagnostic factors

  • constitutional symptoms
  • lower extremity swelling
  • hepatic fetor
  • muscle wasting
  • peripheral edema
  • recurrent infections
  • decreased libido
  • chest wall features (e.g., gynecomastia)
  • dyspnea
  • chest pain
  • syncope
Full details

Risk factors

  • alcohol misuse
  • intravenous drug use
  • unprotected intercourse
  • obesity
  • country of birth
  • blood transfusion
  • tattooing
Full details

Diagnostic tests

1st tests to order

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

Tests to consider

  • total iron, total iron binding capacity (TIBC), transferrin saturation, and serum ferritin
  • antinuclear antibody
  • antismooth muscle antibody
  • liver kidney microsomal antibody
  • antimitochondrial antibody
  • serum immunoglobulins
  • serum ceruloplasmin
  • plasma alpha-1 antitrypsin
  • alpha-fetoprotein
  • abdominal ultrasound
  • abdominal CT
  • abdominal MRI
  • upper gastrointestinal endoscopy
  • liver biopsy
  • imaging-based noninvasive tests
  • blood-based noninvasive tests
  • portal pressure assessment
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Consultant Hepatologist (Locum)

Barts Health NHS Trust

London

UK

Disclosures

AK acts as an advisor for Gilead Sciences.

Professor and Consultant Hepatologist

Barts Liver Centre

Barts and the London School of Medicine and Dentistry

London

UK

Disclosures

PTFK acts as an advisor for Gilead Sciences, Janssen, and Immunocore. PTFK has received grant funding from Gilead Sciences.

Dr Apostolos Koffas and Professor Patrick T. F. Kennedy would like to gratefully acknowledge Dr Grace E. Dolman, Dr Keith D. Lindor, and Dr Flavia Mendes, previous contributors to this topic.

Disclosures

GED declares that she has no competing interests. KDL is an unpaid advisor for Intercept Pharmaceuticals and Shire Pharmaceuticals. FM declares that she has no competing interests.

Peer reviewers

Assistant Professor - Pediatric Gastroenterology

Hepatology & Nutrition - University of California San Diego

Rady Children’s Hospital San Diego

San Diego

CA

Disclosures

PH declares that he 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.

  • Cirrhosis images
  • Differentials

    • Budd-Chiari syndrome
    • Portal vein thrombosis
    • Splenic vein thrombosis
    More Differentials
  • Guidelines

    • AASLD practice guidance on acute-on-chronic liver failure and the management of critically ill patients with cirrhosis
    • AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis
    More Guidelines
  • Patient information

    Cirrhosis: what is it?

    Cirrhosis: what treatments work?

    More Patient information
  • Calculators

    NAFLD Fibrosis Score

    More Calculators
  • Videos

    Abdominal paracentesis animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer