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
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
Gilberts Patient information
Historically, an abdominal ultrasound has been requested as part of the full liver screen. In line with BMUS and local guidelines agreed with NHS Highland Radiology department, please be aware that an ultrasound may not always be justified as part of first-line investigations.
When is an USS justified as part of full liver screen:
Please record relevant information on Radiology request form:
When an USS is NOT justified as part of full liver screen:
If there is clinical doubt as to whether an USS should be arranged prior to referral to Gastroenterology, please contact livernursespecialists@nhs.scot
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
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
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
For the management of patients with cirrhosis follow the BSG (British Society of Gastroenterology) guidelines. These include the following resources:
Patient information can be found at:
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
https://www.nice.org.uk/guidance/cg165
nhsh.viralhepatitisnurses@nhs.scot
Further information and resources can be accessed via the following link: http://intranet.nhsh.scot.nhs.uk/Clinical/HighlandBloodBorneVirusesManagedCareNetwork/HepCElimination/Pages/Default.aspx
Abdominal Paracentesis - drainage of ascites
Patient information and consent form
Education and competency pack
Spontaneous bacterial peritonitis
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 |
Last reviewed: 20 July 2021
Next review: 20 July 2024
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