Most patients present with a classic symptom triad: abdominal pain, ascites, and hepatomegaly. However, this triad is nonspecific and making the diagnosis of this disease requires that one have a high index of suspicion when the patient exhibits this symptom triad. There are four clinical variants: acute liver disease, subacute liver disease, fulminate liver disease, and liver failure. The most common variant is subacute liver failure with portal hypertension and liver decompensation.

Medical therapy can be instituted for short-term, symptomatic relief. The mortality rate associated with symptomatic treatment is 80% to 85%. Treatment includes anticoagulation, antithrombolytic therapy, and angioplasty. Ascites can be managed with sodium restriction and diuretics, with approximately 95% effectiveness. In the event of hypotension, water restriction may be incorporated. Paracentesis may be used for some patients, but it is typically reserved for the patient with tense ascites in whom rapid symptomatic relief is needed. Invasive/surgical intervention can be undertaken for decompression of the hepatic vascular congestion if portal hypertension is the underlying cause of symptoms. Peritoneovenous shunt placement is an older, almost obsolete, therapeutic measure for symptomatic relief of medically intractable ascites. The placement of this shunt can result in increased cardiac output, renal blood flow, glomerular filtration rate, urinary volume, sodium excretion, and decreased plasma renin activity and plasma aldosterone concentration. There is no evidence of improved patient survival. Currently, the emerging standard treatment is the transjugular intrahepatic portosystemic shunt (TIPS) for alleviation of the hepatic venous congestion. Prognosis for this disease can be good, based on several factors.