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 distension
- esophageal or gastric variceal bleeding
- right upper quadrant abdominal 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
- thorium dioxide radioactive contrast
- hemochromatosis
- cigarette smoking
- alpha-1-antitrypsin deficiency
- porphyria cutanea tarda
- primary biliary cholangitis (PBC)
- primary sclerosing cholangitis (PSC)
- androgenic steroids
- oral contraceptives
- male sex
Diagnostic investigations
1st investigations to order
- complete blood count
- basic metabolic panel
- liver function tests
- prothrombin time/INR
- viral hepatitis panel
- alpha fetoprotein (AFP)
- ultrasound of liver
Investigations to consider
- contrast CT scan of abdomen
- contrast MRI of abdomen
- liver biopsy
- computed tomography scan of chest
- bone scan
Treatment algorithm
Barcelona Clinic Liver Cancer (BCLC) stage 0-A (very early 0 or early disease A): possible surgical candidate (good liver function)
BCLC stage 0-A (very early 0 or early disease A): nonhepatic resection candidate
BCLC stage B: intermediate disease
BCLC stage C: advanced disease
BCLC stage D: end-stage disease
recurrence
Contributors
Authors
Qingyao Daniel Huang, MBBS, MMed (Internal Medicine), MRCP
Associate Consultant
Department of Medicine
Division of Gastroenterology & Hepatology
National University Health System
Singapore
Disclosures
QDH declares that he has no competing interests.
Margaret Li Peng Teng, MBBS, MMed (Singapore), MRCP
Associate Consultant
Department of Medicine
Division of Gastroenterology & Hepatology
National University Hospital
Singapore
Disclosures
MLPT declares that she has no competing interests.
Acknowledgements
Dr Qingyao Daniel Huang and Dr Margaret Li Peng Teng would like to gratefully acknowledge Dr Poh Seng Tan, Dr Badar Muneer, and Dr Smruti R. Mohanty, previous contributors to this topic.
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. 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
Srikrishna Nagri, MD
Gastroenterologist
Dartmouth-Hitchcock Nashua
Nashua
NH
Disclosures
SN declares that he has no competing interests.
Ned Snyder, MD, FACP
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.
Differentials
- Cholangiocarcinoma
- Hepatic adenoma
- Hemangioma of liver
More DifferentialsGuidelines
- ACR Appropriateness Criteria® abnormal liver function tests
- NCCN clinical practice guidelines in oncology: hepatocellular carcinoma
More GuidelinesCalculators
Child Pugh classification for severity of liver disease
More Calculators
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