Pre PACES Podcast #68 Chronic liver disease (part 2)
14 snips
Aug 27, 2023 Dr Phil Berry, consultant hepatologist at Guy's & St Thomas's, explains investigations and management of chronic liver disease in clear, practical terms. He walks through key blood tests, imaging, FibroScan and biopsy roles. Practical care topics include ascites, encephalopathy, coagulopathy, viral and autoimmune treatments, and multidisciplinary long‑term management. Plus a fun Star Wars quiz.
AI Snips
Chapters
Transcript
Episode notes
Prioritise Baseline Blood Tests
- Check FBC, renal function, electrolytes and LFTs early to guide acute management of chronic liver disease.
- Use INR thoughtfully and remember vitamin K or biliary obstruction can raise it; correct coagulation only if bleeding or invasive procedure is happening.
Read Liver Enzyme Patterns Carefully
- Interpret enzyme patterns: alkaline phosphatase and GGT suggest cholestatic disease, while ALT/AST suggest hepatocellular injury.
- Use AST:ALT ratio and FIB-4 (age, platelets, AST, ALT) as adjuncts but not definitive alone.
Order A Focused Noninvasive Liver Screen
- Include viral serology (HBsAg, HCV antibody → RNA if positive) and HIV when screening for chronic liver disease.
- Screen ferritin/transferrin saturation, ceruloplasmin, alpha-1 antitrypsin and autoantibodies plus immunoglobulins as part of an aetiology-focused workup.