Last reviewed:December 2019
Last updated:January  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)
Full details

Treatment algorithm

Contributors

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.

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.

Peer reviewersVIEW ALL

Assistant Professor

Department of Gastroenterology

University of California

San Francisco

CA

Disclosures

SS declares that he has no competing interests.

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