Common liver diseases: support and resources

General liver disease support and guidance: The British liver trust: https://britishlivertrust.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/
NHS Lothian Scottish Liver Transplant
Scottish Palliative Care Guidelines

Advice on diet in chronic liver disease

Hepatitis C:
NHS Highland Blood Borne Viruses Managed Care Network (scot.nhs.uk)

Referral pathway for abnormal liver bloods in over 16’s

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

Additional information: When to request USS as part of a full liver screen.

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:

  • ALT or ALP is greater than 2.5 x ULN or rising suddenly
  • Patient has signs and symptoms of advanced liver disease (Please see referral pathway for abnormal liver bloods in over 16s)
  • Suspicion of biliary obstruction or cholecystitis
  • Suspicion of malignancy

Please record relevant information on Radiology request form:

  • Which LFTs are deranged, by how much and for how long?
  • Patient symptoms (including weight loss)
  • A specific diagnosis (if known)

When an USS is NOT justified as part of full liver screen:

  • Isolated single liver enzyme rise (Please see referral pathway for abnormal liver bloods in over 16s)
  • Asymptomatic patient with single episode of mild to moderate rise in liver enzymes
  • Patient with known high risk factors for NAFLD (type 2 diabetes, obesity, hypertension, hyperlipidaemia) - Where NAFLD is the likely diagnosis, fibrosis risk stratification (pathway B) is more useful than ultrasound.
  • Patient on drugs known to cause hepatic enzyme rises (eg. Statins) – please stop drug and repeat liver enzyme tests in 1-3 months

If there is clinical doubt as to whether an USS should be arranged prior to referral to Gastroenterology, please contact livernursespecialists@nhs.scot

Pathway A - Abnormal LFTS related to Alcohol

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

Alcohol support services and resources


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



Pathway B - Non alcoholic fatty liver disease (Nafld) for use in adults only (not for use in children or pregnant women)

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

NICE guideline
BSG guideline


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.

For further information see: Updates in Haemochromatosis. The British Society of Gastroenterology (bsg.org.uk)

Viral hepatitis



Further information and resources can be accessed via the following link: NHS Highland Hepcelination


OTCOver the counter
USSUltrasound scan
ALPAlkaline phosphatase
GGTGamma-glutamyl transferas
INRInternational normalized ratio
RUQRight upper quadrant
ASTAspartate aminotransferase
AMAAnti-Mitochondrial Antibody 
ASMAAnti-smooth muscle antibody
BMIBody mass index
LFTLiver function test
ANAAntinuclear antibody
BPBlood Pressure
PCRPolymerase chain reaction
NAFLDNon-alcoholic fatty liver disease
BBVBlood borne virus
BSGBritish Society for Gastroenterology
DBSDry blood spot
NaVHepatitis A virus
HBVHepatitis B virus
HCVHepatitis C virus
HBV eAgHepatitis B virus e antigen
ALDAlcohol related liver disease

Editorial Information

Last reviewed: 20/07/2021

Next review date: 20/07/2024

Author(s): Liver guideline and pathway group.

Version: V1.1

Approved By: TAM subgroup of ADTC

Reviewer name(s): Dr Andrea Broad, Consultant Gastroenterologist and Liver nurse specialist.

Document Id: TAM444