Last reviewed: 23 Aug 2023
Last updated: 07 Jul 2022
Summary
Definition
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
More key diagnostic factors
Other diagnostic factors
- splenomegaly
Other diagnostic factors
Risk factors
- portal hypertension
- large varices
- red wale marks
- Child-Pugh class
- ascites
More risk factors
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)
More 1st investigations to order
Emerging tests
- capsule endoscopy
Treatment algorithm
ACUTE
decompensated cirrhosis with acute variceal hemorrhage (hepatic venous pressure gradient >12 mmHg)
decompensated cirrhosis with acute variceal hemorrhage and failed endoscopic/pharmacologic therapy
ONGOING
compensated cirrhosis with mild portal hypertension (hepatic venous pressure gradient >5 and <10 mmHg)
compensated cirrhosis with clinically significant portal hypertension (hepatic venous pressure gradient ≥10 mmHg): without gastroesophageal varices
compensated cirrhosis with clinically significant portal hypertension (hepatic venous pressure gradient ≥10 mmHg): with gastroesophageal varices (no bleeding)
previous variceal bleed
Contributors
Authors
Grace E. Dolman, PhD, MA (Cantab), MRCP
Clinical Research Fellow
Barts Liver Centre
Barts and the London School of Medicine and Dentistry
London
UK
Disclosures
GED declares that she has no competing interests.
Acknowledgements
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.
Disclosures
GDA, GM, VB, and TB declare that they have no competing interests.
Peer reviewers
Shreyas Saligram, MD, MRCP, FACG, FASGE
Assistant Professor
Department of Gastroenterology
University of California
San Francisco
CA
Disclosures
SS declares that he has no competing interests.
Differentials
- Hiatal hernia
- Gastric varices
- Mallory-Weiss tear
More DifferentialsGuidelines
- Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period
- Esophageal emergencies
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