Box 1.

History and investigations

History

Symptoms leading to current presentation

History of known liver disease

Previous decompensations/complications of liver disease

Previous endoscopies – any known varices?

Infective symptoms – fever, dysuria, shortness of breath, cough, painful or swollen joints, rashes

Bowel habit? Constipation? Meleana/haematemasis

Recent foreign travel

Abdominal pain or swelling

Alcohol consumption (units/day) – currently and in the past

Medications and compliance

Recreational drug use / over the counter medication

Initial baseline investigations

Blood tests: full blood count, C-reactive protein, urea and electrolytes, liver enzymes, coagulation, lactate, bone profile, magnesium, blood glucose, venous/arterial blood gas, alpha fetoprotein, alcohol level

Chest X-ray

Urinalysis, microscopy, culture and sensitivity

Blood cultures

Ascitic tap in those with ascites – white cell count and differential, culture and fluid albumin

Doppler ultrasound abdomen