LIVER

What's New

Information on Cirrhosis.

Common liver diseases: support and resources

General liver disease support and guidance: The British liver trust: https://britishlivertrust.org.uk/

Haemochromatosis: https://www.haemochromatosis.org.uk/

Auto immune diseases:
Auto immune hepatitis (AIH): https://aihsupport.org.uk/ 
Primary biliary cholangitis (PBC): https://www.pbcfoundation.org.uk/ 
The management of itch in PBC: https://fg.bmj.com/content/7/3/158.full 
Primary sclerosing cholangitis  (PSC): https://www.pscsupport.org.uk/
Scottish Liver Transplant: https://services.nhslothian.scot/scottishlivertransplantunit/Pages/default.aspx
Scottish Palliative Care Guidelines

Advice on diet in chronic liver disease

Referral pathway for abnormal liver bloods in over 16’s


Gilberts Patient information

Full liver screen includes USS, liver bloods including GGT and AST, Hep B surface antigen, Hep C antibodies, AMA, ASMA and ANA antibodies, serum immunoglobulins and simultaneous ferritin and transferrin saturations
NICE Guideline
BSG Guideline

Pathway A - Abnormal LFTS related to Alcohol

MDCalc - AUDIT-C for alcohol use

Driving Advice:  It is the driver’s responsibility to contact the DVLA if they are persistently misusing alcohol or dependent on alcohol.  This will result in revocation of their licence. At follow up, if the patient has not informed the DVLA, you should inform the DVLA if patient refuses.

Consider Thiamine: Deficiency is common in alcohol drinkers due to poor diet, poor absorption secondary to gastritis and high demand for the vitamin as it is a coenzyme in alcohol metabolism. Thiamine deficiency can cause Wernicke’s encephalopathy, which, if not treated, can result in Korsakoff’s syndrome and irreversible brain damage.
NICE Guideline
BSG Guideline
NHS Scotland Alcohol Brief Intervention Resources - http://www.healthscotland.scot/publications/alcohol-brief-intervention-resources

Alcohol support services and resources

 07816228492

Inverness Community Teams (includes DARS, DTTO, Homeless Service and Dual Diagnosis Badenoch and Strathspey

 01847 891224

Caithness / Sutherland

 01463 716888

Osprey House and HADASS

01463 705650

Nairn, Ardersier, Mid and East Ross

 01854 612794

Wester Ross, Skye and Lochalsh

01397 709830

Lochaber

http://www.highland-adp.org.uk/userfiles/file/service_directory/Directory-of-Services-24122018.pdf

Pathway B - Non alcoholic fatty liver disease (Nafld) for use in adults only (not for use in children or pregnant women)

Asymptomatic Abnormal LFTs - if clinical signs of cirrhosis or any red flag symptoms refer urgently
Fib 4 calculator can be found here
Full liver screen includes USS, liver bloods including GGT and AST, Hep B surface antigen, Hep C antibodies, AMA, ASMA and ANA antibodies, serum immunoglobulins and simultaneous ferritin and transferrin saturations

NICE guideline
BSG guideline

Haemochromatosis

Patient consent - Genetic request form 
Hfe mutation testing requirements are three red top tubes or a single large blue top tube, If preferred samples and request form can be sent directly to the DNA Laboratory, Medical School, Foresterhill, Aberdeen, AB25 2ZD
EASL - management of hfe haemochromatosis
British Society of Haematology - Diagnosis and therapy of genetic haemochromatosis

Glossary
Abbreviation Meaning
OTC Over the counter
USS Ultrasound scan
ALP Alkaline phosphatase
GGT Gamma-glutamyl transferas
INR International normalized ratio
RUQ Right upper quadrant
HPB Hepatico-pancreatico-biliary
AST Aspartate aminotransferase
AMA Anti-Mitochondrial Antibody 
ASMA Anti-smooth muscle antibody
BMI Body mass index
LFT Liver function test
ANA Antinuclear antibody
BP Blood Pressure
PCR Polymerase chain reaction
NAFLD Non-alcoholic fatty liver disease
BBV Blood borne virus
BSG British Society for Gastroenterology
DBS Dry blood spot
NaV Hepatitis A virus
HBV Hepatitis B virus
HCV Hepatitis C virus
HBV eAg Hepatitis B virus e antigen
ALD Alcohol related liver disease
Editorial Information

Last reviewed: 28 February 2020

Next review: 28 February 2023

Author(s): Liver guideline and pathway group

Approved By: TAM subgroup of ADTC

Reviewer Name(s): Consultant Gastroenterologist and Liver nurse specialist

Document Id: TAM444