History and exam
Key diagnostic factors
common
cirrhosis
Fifty percent of patients with cirrhosis have gastroesophageal varices.[41]
severe liver disease
Between 50% and 85% of patients with Child-Pugh class C have gastroesophageal varices.[41]
alcohol misuse
Chronic alcohol misuse is a risk factor for development of alcoholic hepatitis and alcoholic cirrhosis.
hepatitis B or C infection
Chronic hepatitis B or C infection may lead to cirrhosis and esophageal 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 hemorrhage.
caput medusa
Abdominal wall vascular collaterals are an important clinical sign and consequence of severe portal hypertension.
jaundice
May indicate advanced liver disease.
encephalopathy
Provides evidence of decompensated cirrhosis, which is an important factor associated with development and progression of varices.
hematemesis
Common in patients who have actively bleeding varices, but absent in varices that are not actively bleeding.
melena
Common in patients who have actively bleeding varices, but absent in varices that are not actively bleeding.
hematochezia
Common in patients who have actively bleeding varices and are hemodynamically unstable.
uncommon
HIV coinfection
HIV coinfection in patients with hepatitis B or C may accelerate deterioration of chronic liver disease toward cirrhosis.
Other diagnostic factors
common
splenomegaly
Patients with splenomegaly often have thrombocytopenia and anemia, owing to pooling of blood and sequestration of blood components in the spleen in the setting of portal hypertension.
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