History and exam
Key diagnostic factors
common
presence of risk factors for variceal bleeding
haematemesis
Common in patients who have actively bleeding varices, but absent in varices that are not actively bleeding. Patients with haematemesis tend to have more severe bleeds than those with only melaena.[40]
melaena
Common in patients who have actively bleeding varices, but absent in varices that are not actively bleeding.
haematochezia
Common in patients who have actively bleeding varices and are haemodynamically unstable.
cirrhosis
About 50% of patients with cirrhosis have gastro-oesophageal varices.[41]
severe liver disease
Between 50% and 85% of patients with Child-Pugh class C have gastro-oesophageal varices.[41]
alcohol misuse
Excessive chronic alcohol consumption is a risk factor for development of alcoholic hepatitis and alcoholic cirrhosis.
Practical tip
Watch for typical withdrawal symptoms after admission.[5] See our topic Alcohol withdrawal.
intravenous drug use
People who inject drugs are at risk of contracting hepatitis B and C.
Practical tip
Watch for typical withdrawal symptoms after admission.[5] See our topic Opioid use disorder.
hepatitis B or hepatitis C infection
Chronic hepatitis B or C infection may lead to cirrhosis and oesophageal varices. The incidence is increased when combined with alcohol misuse.
ascites
Provides evidence of decompensated cirrhosis, which is an important factor associated with development and progression of varices.
spider angioma
Multiple spider angiomas are a feature of chronic liver disease and cirrhosis. The number and size correlate with the severity of chronic liver disease. Patients with numerous large angiomas are at increased risk of variceal haemorrhage.
caput medusa
Abdominal wall vascular collaterals are an important clinical sign and consequence of severe portal hypertension.
jaundice
May indicate advanced liver disease.
encephalopathy
Evidence of decompensated cirrhosis, which is an important factor associated with development and progression of varices.
uncommon
HIV co-infection
HIV co-infection in patients with hepatitis B or C may accelerate deterioration of chronic liver disease towards cirrhosis.
Other diagnostic factors
common
splenomegaly
Patients with splenomegaly often have thrombocytopenia and anaemia, owing to pooling of blood and sequestration of blood components in the spleen in the setting of portal hypertension.
Use of this content is subject to our disclaimer