Last reviewed: 1 Feb 2021
Last updated: 15 Jan 2020



History and exam

Key diagnostic factors

  • cirrhosis
  • more severe liver disease
  • alcohol misuse
  • hepatitis B or C infection
  • ascites
  • spider angioma
  • caput medusa
  • jaundice
  • encephalopathy
  • hematemesis
  • melena
  • hematochezia
  • HIV coinfection

Risk factors

  • portal hypertension
  • large varices
  • red wale marks
  • Child-Pugh class
  • ascites

Diagnostic investigations

1st investigations to order

  • hepatic venous pressure gradient (HPVG)
  • complete blood count
  • coagulation profile (INR/prothrombin time)
  • serum LFTs
  • BUN and creatinine
  • blood typing/cross-matching
  • hepatitis B surface antigen (HBsAg)
  • anti-hepatitis C virus IgG (anti-HCV IgG)
  • esophago-gastro-duodenoscopy (EGD)

Treatment algorithm


Clinical Research Fellow

Barts Liver Centre

Barts and the London School of Medicine and Dentistry




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.


GDA, GM, VB, and TB declare that they have no competing interests.

Peer reviewersVIEW ALL

Assistant Professor

Department of Gastroenterology

University of California

San Francisco



SS declares that he has no competing interests.

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