Patients with suspected liver disease, except viral hepatitis and cancer, should now be referred via e-Referral Service (ERS) or Advice & Guidance (A&G)/Advice & Refer (A&R), according to the pathway designed in line with national best practice. Direct access to Fibroscan – previously offered by NLaG - is no longer available.
Practices should use this pathway when liver disease is suspected and include appropriate scores e.g. Fib4/ELF as applicable, to support triage decisions. A&G/A&R can be used at any point to seek specialist input and potentially avoid unnecessary secondary care referrals 

Please use the red flag/urgent advice provided on the pathway if uncertain

For immediate referral to Hepatology:

Confirmed cirrhosis

Suspected decompensated cirrhosis – ascites/encephalopathy

See pathway for advice, which is cause-specific. All patients can look at the British Liver Trust website, which has patient information freely available.

MASLD: For people with MASLD (metabolic dysfunction associated steatotic liver disease – the new name for NAFLD), and a low risk Fib4/ELF/Fibroscan, there is very little risk of liver related adverse outcomes. They do though, have increased risk of cardiovascular, cerebrovascular disease, and CKD. They should be managed in primary care with focus on cardiovascular risk reduction and healthy lifestyle (healthy weight + appropriate advice on target/how to achieve), alcohol within recommended national limits, healthy diet (EatWell plate) and physical exercise, all as per standard NHS advice.

Alcohol – For those with low risk of fibrosis as per ELF/Fibroscan, the focus should be alcohol reduction, with help of community alcohol support services/signposting, where needed.

Please follow the pathway flowchart for all patients with suspected liver disease. This includes triggers for referral and required investigations.

Please refer using ERS or Advice & Refer

Do not refer

Suspected Liver Cancer or Obstructive Disease – DO NOT REFER TO HEPATOLOGY – refer to 2ww/Upper GI surgery, respectively

Suspected viral hepatitis – DO NOT REFER TO HEPATOLOGY – refer to Infectious Diseases Viral Hepatitis team

 

British Liver Trust - Pioneering Liver Health

Overview | Cirrhosis in over 16s: assessment and management | Guidance | NICE