Last reviewed:September 2019
Last updated:October  2019

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
  • bone 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 cholangitis (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
Full details

Investigations to consider

  • contrast CT scan of abdomen
  • contrast MRI of abdomen
  • liver biopsy
  • computed tomography scan of chest
  • bone scan
Full details

Treatment algorithm

Contributors

Senior Consultant, Gastroenterology & Hepatology

Assistant Professor, Yong Loo Lin School of Medicine

National University of Singapore

Singapore

Disclosures

PST has received sponsorship/honorarium from Bayer (South East Asia) Pte Ltd and Sirtex for attending conferences, delivering lectures, and participating in advisory board meetings.

Associate Consultant

Department of Medicine

Division of Gastroenterology & Hepatology

National University Health System

Singapore 

Disclosures

QDN declares that he has no competing interests.

Dr Poh Seng Tan and Dr Qingyao Daniel Huang would like to gratefully acknowledge Dr Badar Muneer and Dr Smruti R. Mohanty, previous contributors to this topic.

Peer reviewersVIEW 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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