Summary
Definition
History and exam
Key diagnostic factors
- history of cirrhosis
- history of chronic hepatitis B (HBV) or C (HCV)
- history of chronic heavy alcohol use
- history of diabetes or obesity
- family history of liver cancer
- older age
- hepatomegaly
Other diagnostic factors
- abdominal distention
- esophageal or gastric variceal bleeding
- right upper quadrant pain
- early satiety
- weight loss
- leg edema
- hepatic encephalopathy
- cachexia
- jaundice
- splenomegaly
- asterixis
- spider nevi
- palmar erythema
- periumbilical collateral veins
- fetor hepaticus
- diarrhea
- paraneoplastic syndrome
- bony pain
- severe abdominal pain
- obstructive jaundice
- enlarged hemorrhoidal veins
- vascular bruit
Risk factors
- cirrhosis
- chronic hepatitis B (HBV) infection
- chronic hepatitis C (HCV) cirrhosis
- chronic heavy alcohol use
- diabetes
- obesity
- family history of liver cancer
- aflatoxin
- Thorotrast radioactive contrast
- hemochromatosis
- cigarette smoking
- alpha-1-antitrypsin deficiency
- porphyria cutanea tarda
- primary biliary cirrhosis (PBC)
- primary sclerosing cholangitis
- androgenic steroids
- oral contraceptives
- male sex
Diagnostic investigations
1st investigations to order
- complete blood count
- basic metabolic panel
- liver function tests
- prothrombin time/international normalized ratio
- viral hepatitis panel
- alpha fetoprotein (AFP)
- ultrasound of liver
Investigations to consider
- contrast computed tomography (CT) scan of abdomen
- contrast magnetic resonance imaging (MRI) of abdomen
- liver biopsy
- computed tomography scan of chest
- bone scan
Treatment algorithm
Contributors
Authors VIEW ALL
Consultant, Gastroenterology & Hepatology
Assistant Professor, Yong Loo Lin School of Medicine
National University of Singapore
Singapore
Disclosures
PST has received a speaker honorarium from GE Healthcare, Bayer, and Sirtex. PST has received travel and accommodation arrangements for medical conferences from Bristol-Myers Squibb, Gilead, Sirtex, Bayer, and Novartis.
Dr Poh Seng Tan would like to gratefully acknowledge Dr Badar Muneer and Dr Smruti R. Mohanty, previous contributors to this monograph. BM declares that he has no competing interests. SRM serves as a speaker for Bristol-Myers Squibb regarding the use of entecavir for the treatment of chronic hepatitis B.
Peer reviewers VIEW ALL
Gastroenterologist
Dartmouth-Hitchcock Nashua
Nashua
NH
Disclosures
SN declares that he has no competing interests.
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
Galveston
TX
Disclosures
NS declares that he has no competing interests.
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