What are the key clinical features to assess in a patient with suspected cirrhosis?

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 ². 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 ² (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 ¹. A comprehensive alcohol history is essential to differentiate alcohol-related liver disease ³.

Furthermore, assess for any existing comorbidities or complications of cirrhosis, as early recognition by primary healthcare professionals is crucial for specialist liaison and management ² (Muir, 2015). Specific assessments should include evaluating the patient's nutritional status to identify any risk of malnutrition, particularly in those with decompensated disease ². It is also important to assess the patient's fracture risk and the risk of osteoporosis ².

It is important to note that routine laboratory liver blood tests should not be used to rule out cirrhosis ¹ or non-alcoholic fatty liver disease (NAFLD) ³.