Last reviewed: 7 Nov 2021
Last updated: 15 Jan 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors for variceal bleeding
  • cirrhosis
  • more severe liver disease
  • alcohol misuse
  • hepatitis B or C infection
  • ascites
  • spider angioma
  • caput medusa
  • jaundice
  • encephalopathy
  • haematemesis
  • melaena
  • haematochezia
  • HIV co-infection

Risk factors

  • portal hypertension
  • large varices
  • red wale marks
  • Child-Pugh class
  • ascites

Diagnostic investigations

1st investigations to order

  • hepatic venous pressure gradient (HPVG)
  • full blood count
  • coagulation profile (INR/prothrombin time)
  • serum LFTs
  • urea and creatinine
  • blood typing/cross-matching
  • hepatitis B surface antigen (HBsAg)
  • anti-hepatitis C virus IgG (anti-HCV IgG)
  • oesophago-gastro-duodenoscopy (OGD)

Treatment algorithm

Contributors

Authors

Grace E. Dolman, PhD, MA (Cantab), MRCP

Clinical Research Fellow

Barts Liver Centre

Barts and the London School of Medicine and Dentistry

London

UK

Disclosures

GED declares that she has no competing interests.

Acknowledgements

Dr Grace E. Dolman would like to gratefully acknowledge Dr Gennaro D'Amico, Dr Giuseppe Malizia, Dr Vikram Boolchand, and Dr Thomas Boyer, previous contributors to this topic.

Disclosures

GDA, GM, VB, and TB declare that they have no competing interests.

Peer reviewers

Shreyas Saligram, MD, MRCP, FACG, FASGE

Assistant Professor

Department of Gastroenterology

University of California

San Francisco

CA

Disclosures

SS declares that he has no competing interests.

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