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
- thorium dioxide 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
Investigations to consider
- contrast CT scan of abdomen
- contrast MRI of abdomen
- liver biopsy
- computed tomography scan of chest
- bone scan
Treatment algorithm
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
QDN declares that he has no competing interests.
Acknowledgements
Dr Qingyao Daniel Huang 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.
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