Nice | Who should we be testing for cirrhosis?

This is a new guideline from NICE on cirrhosis. The most important bit for us is knowing who should be tested as we may need to be referring these patients on.

Higher risk patients

  • Hepatitis B
  • Hepatitis C
  • Misuse of alcohol
  • BMI of 30 or more
  • Type 2 diabetes

Who should be tested for cirrhosis?

It is important not to just rely on normal LFTs to rule out cirrhosis. A significant proportion of patients with cirrhosis will have normal LFTs. Therefore the following patients need referral for testing:

NB - patients with a high BMI or T2DM only need testing if they also meet the NAFLD criteria above.

Who needs retesting?

Every 2 years:

  • People with alcohol-related liver disease
  • NAFLD with advanced liver fibrosis
  • Hep C who have not had a sustained response to antiviral therapy

Every year:

  • Hep B if they are not taking antiviral therapy.

Screening for Hepatocellular Carcinoma

Patients diagnosed with cirrhosis will be screened with ultrasound (with or without serum AFP testing) every 6 months unless they are for palliative treatment.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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