Screen for Complications

Top tips:

  1. Patients with compensated cirrhosis and fibroscan based liver stiffness <20 kPa AND platelet count >150,000, do not need endoscopy to screen for varices
  2. Patients with cirrhosis should undergo HCC surveillance with ultrasound and AFP every six months (notably, although by guidelines the AFP is optional, in our experience this is suggested)
  3. Patients who have had a diagnosis of cirrhosis at anytime (regardless of whether they have improved or even cleared their Hepatitis B or C) should continue to undergo HCC surveillance
Dr. Ramji cartoon
Dr. fung cartoon
Dr. Burak cartoon

Check out the bottom of the page for short video bytes from Dr. Ramji, Dr. Fung and Dr. Burak!

Screening for liver related complications

Compensated cirrhosis

Defined by: the absence of ascites, hepatic encephalopathy, variceal bleeding or jaundice (see more info)

Decompensated cirrhosis

Defined by: the presence of ascites, hepatic encephalopathy, variceal bleeding or jaundice (see more info)

Introducing Dr. Ramji, Dr. Fung and Dr. Burak

Video 1 - The top tips that may be useful for you to know about this page as a family physician including: The recommended follow-up investigations in cirrhosis - ultrasound, labs, varices.

Coming soon!

Video 2 - Automating HCC surveillance - information about automatic recall ultrasound surveillance recall programs in Calgary and Edmonton.

Patient materials:

You can direct patients to the following:

What is HCC?

Diagnosing HCC

Treating HCC

Liver biopsy

Lab tests

Downloadable content:

You can download these to print or view offline:

Baveno guidelines 2015

AASLD Guidance 2018

EASL Clinical Practice Guidelines

References:

This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.

Authors: Michelle Carbonneau NP, Dr. Alnoor Ramji, Dr. Puneeta Tandon

References:

  1. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018 Aug;69(2):406-460 PMID 29653741
  2. de Franchis R et al. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015 Sep; 63(3):743-52 PMID 26047908
  3. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018 Jul;69(1):182-236 PMID 29628281
  4. Loomba R et al. AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology 2020 Jan 29 PMID 32006545
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