Long-standing hepatic injury (>6 months) with fibrosis ± cirrhosis from any cause.
Etiology
- • Alcohol, NAFLD, viral hepatitis B/C
- • Autoimmune, haemochromatosis, Wilson, α1AT
- • Drug-induced
History taking
- • Jaundice, ascites, encephalopathy, variceal bleed
- • Alcohol units, IV drug use, tattoos, transfusions
Examination
- • Stigmata: spider naevi, palmar erythema, gynaecomastia, splenomegaly, ascites, asterixis
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • LFT, INR, albumin, CBC
- • Viral hepatitis screen, ANA/SMA, ferritin, ceruloplasmin
- • USS abdomen, FibroScan
- • AFP + USS 6-monthly for HCC surveillance in cirrhosis
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat cause
- • Vaccinate (HAV, HBV, pneumococcal, influenza)
- • Variceal screening
- • Salt restriction, diuretics for ascites
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Strict alcohol abstinence
- • Avoid hepatotoxic drugs / herbal
- • Paracetamol max 2 g/day
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
