Patient discussions
Patients should participate in prevention strategies that improve their liver function. Self-help management will depend on the aetiology of the portal hypertension.
Screening and surveillance (all patients)
Explain the rationale for screening/surveillance (detecting varices early and preventing first bleed); emphasise shared decision-making about endoscopy vs. non-invasive approaches.[51]
Encourage attendance at follow-up and investigations; agree how results will be communicated and what actions will follow.[51]
Clarify who to contact if appointments are missed or if symptoms change.[51]
Additional counselling for people with cirrhosis
Alcohol: encourage reduction/abstinence and sustained, supported behaviour change to lower bleeding risk. Offer referral to treatment services and peer support (e.g., Alcoholics Anonymous, SMART Recovery) and continue engagement even after initial abstinence. Ensure access to social support, medical care, and clinic follow-up, especially during periods of stress, anxiety, work/family difficulty, or increased cravings. See Alcohol-related liver disease.
Nutrition & activity: discuss regular meals with adequate protein and building up physical activity over time (e.g., towards 150 minutes/week of moderate exercise plus strength work), ideally with dietetic/physiotherapy input to support weight management and muscle health.[51]
See Cirrhosis.
Safety-netting
Explain when to seek urgent help for suspected bleeding (e.g., haematemesis, black/tarry stools, faintness/dizziness, or any sudden deterioration), and provide local emergency/contact pathways.[51]
Highlight decompensation red flags (e.g., worsening jaundice, increasing abdominal swelling, confusion/sleep-wake reversal, new leg swelling), why they matter, and whom to contact urgently.[51]
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