Wd.nottinghamcitycare.nhs.uk
Nottinghamshire Adult Liver Disease Stratification pathway
Information required to request a Fibroscan
Hazardous alcohol
This encompasses both those with alcohol dependence / alcoholism as well as those whose drinking is excessive (M> 50 U/week or F>35 U/week for several months).
Read codes:
|Hazardous Alcohol Use |XaKVA |
|Harmful Alcohol Use |XaKVB |
|Problem Drinker |Ub01R |
|Higher Risk Drinking |XaXje |
|Chronic Alcoholism |XE1YQ |
|Alcohol Abuse |Xa1y2 |
|Alcohol intake above recommended sensible limits |136K |
|Alcohol Dependence Syndrome NOS |E232 |
For those with alcohol dependence / alcoholism they need to be willing to consider reducing their drinking before deciding whether to scan.
For those with excessive drinking there is good evidence that brief intervention is helpful in changing behaviours, which can be included in the consultation when discussing the scan
Diabetes/Metabolic syndrome/Fatty liver on USS
1) If there is type 2 diabetes and abnormal LFTs use the abnormal LFT part of this pathway.
2) Required to calculate the Fatty Liver Index (FLI):
• BMI
• waist circumference
• Gamma GT
• Triglyceride levels
Calculators are available on EMIS and TPP and a calculator can also be found on ICE.
Or Google: “Fatty Liver Index Calculator”
Abnormal LFTs
Fibroscan only indicated to stratify liver failure risk for raised ALT side of algorithm. It is not a diagnostic tool, hence screening for underlying cause of liver disease is essential:
• Hepatitis B & C
• Ferritin
• ANA
• Liver autoantibodies
• Immunoglobulins
-----------------------
High bilirubin (up to 50) + normal liver enzymes & normal FBC
Type 2 diabetes or
metabolic syndrome *
syndrome *
BMI > 35
Calculate Fatty Liver Index (FLI*) via ICE
Incidental fatty
liver on USS
Hazardous alcohol *
Asymptomatic Abnormal LFTs
Consider gallstones
BUT Jaundice or
possible cancer
Symptomatic + Abnormal
Liver Enzymes
Nottinghamshire Adult Liver
Disease Stratification pathway
Two week wait
Hepatobilary referral
FLI < 60
Consider checking conjugated /unconjugated bilirubin to confirm Gilbert’s Disease –benign condition
Willing to consider lifestyle behaviours
FLI > 60
Re check FLI every 5 years
NAFLD
Raised ALT
Raised Alk Phos only(>160)*
GGT then done automatically
Hepatitis B & C*
ANA
Liver autoantibodies
Immunoglobulins
Ferritin *
Refer +ves
to Hepatology
Raised Alk Phos with normal GGT
Raised Alk Phos with raised GGT
Refer for Fibroscan
ALT >100*
but
AST/ALT
Ratio ................
................
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