When assessing a patient with suspected cirrhosis, it is critical to identify signs of decompensated liver disease, as these necessitate emergency hospital admission or immediate referral to a hepatologist or gastroenterologist NICE CKS. Key clinical features of decompensated cirrhosis include worsening symptoms of encephalopathy, which may manifest as non-specific, subtle cognitive impairment, and an increasing volume of ascites NICE CKS (Shawcross, 2016).
Initial assessment should also involve identifying risk factors for cirrhosis, such as hepatitis B virus infection, hepatitis C virus infection, alcohol misuse, obesity (body mass index [BMI] of 30 kg/m² or higher), and type 2 diabetes NICE NG50. A comprehensive alcohol history is essential to differentiate alcohol-related liver disease NICE NG49.
Furthermore, assess for any existing comorbidities or complications of cirrhosis, as early recognition by primary healthcare professionals is crucial for specialist liaison and management NICE CKS (Muir, 2015). Specific assessments should include evaluating the patient's nutritional status to identify any risk of malnutrition, particularly in those with decompensated disease NICE CKS. It is also important to assess the patient's fracture risk and the risk of osteoporosis NICE CKS.
It is important to note that routine laboratory liver blood tests should not be used to rule out cirrhosis NICE NG50 or non-alcoholic fatty liver disease (NAFLD) NICE NG49.
Key References
- NG50 - Cirrhosis in over 16s: assessment and management
- CKS - Cirrhosis
- NG49 - Non-alcoholic fatty liver disease (NAFLD): assessment and management
- (Lackner and Tiniakos, 2019): Fibrosis and alcohol-related liver disease.
- (Campos-Murguía et al., 2020): Clinical assessment and management of liver fibrosis in non-alcoholic fatty liver disease.