Last reviewed: 4 Jul 2021
Last updated: 16 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • advanced cirrhosis
  • jaundice
  • ascites

Other diagnostic factors

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

Risk factors

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

Diagnostic investigations

1st investigations to order

  • creatinine
  • urea
  • electrolytes
  • FBC
  • LFTs
  • coagulation study
  • diagnostic paracentesis and culture of ascitic fluid
  • blood culture
  • urinalysis and culture
  • CXR

Treatment algorithm

Contributors

Authors

John Kepros, MD
John Kepros

Trauma Medical Director

HonorHealth Osborn Hospital

Scottsdale

AZ

Disclosures

JK declares that he has no competing interests.

Peer reviewers

Howard J. Worman, MD

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.

George Y. Wu, MD, PhD

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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