Presentations
- Abnormal imaging (e.g. cirrhosis, liver lesions, portal hypertension)
- Abnormal liver function tests (LFTs)
- Ascites
- Bleeding varices:
- ectopic (e.g., stomal)
- gastric
- oesophageal
- rectal
- Bruising
- Cholangitis
- Encephalopathy
- Fever
- Jaundice
- Nausea/Vomiting
- Pain:
- abdominal
- right upper quadrant (RUQ)
- Pruritus
- Severe liver injury/liver failure (acute/chronic/acute on chronic)
- Weight loss
Conditions
- Abnormal LFT in previously well and unwell patients
- Acute hepatitis
- Alcoholic liver disease:
- alcoholic hepatitis
- chronic liver disease
- Autoimmune liver disease
- Biliary disease:
- autoimmune (e.g. primary biliary cholangitis, primary sclerosing cholangitis, IgG4 spectrum of diseases)
- infective (e.g. flukes)
- Cholestatic liver diseases
- Cirrhosis, including managing complications:
- Cirrhotic and non-cirrhotic portal hypertension
- Complications of portal hypertension
- Drug-induced liver injury
- Hepatic failure:
- Hepatic decompensation
- Hepatocellular carcinoma (HCC)
- Inherited and metabolic liver disease
- Liver lesions:
- Metabolic disorders (e.g. haemochromatosis, Wilson disease)
- Metabolic dysfunction-associated fatty liver disease (NAFLD/MAFLD)
- Portal vein thrombosis
- Pregnancy-related liver disease
- Vascular liver disorders
- Viral hepatitis
PCH
Presentations
- Enlarged liver
- Failure to thrive
- Malnutrition
Conditions
- Alagille syndrome
- Bile acid transport defects (e.g. progressive familial intrahepatic cholestasis defects)
- Biliary atresia
- Congenital metabolic disorders (fatty acid transport, glycogen storage diseases, glycosylation, mitochondrial defects)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Adults with lifelong congenital liver disease:
- alpha 1 antitrypsin deficiency
- biliary atresia
- congenital hepatic fibrosis
- cystic fibrosis liver disease
- Fontan liver disease
- Principles of management for post-liver transplant patients
PCH
- Metabolic disease requiring liver transplantation
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Pathophysiology:
- assessment and management of coagulation in cirrhosis
- gastrointestinal and hepatic complications of therapies (e.g. immune checkpoint inhibitors)
- Principles of oncology (e.g. cholangiocarcinoma, HCC)
- Public health matters (e.g. addiction and drug services, alcohol, obesity, viral hepatitis)
PCH
- Pathophysiology of other causes of cholestasis in the neonatal period and infancy (including bile acid transport disorders, causes of unconjugated jaundice e.g. Crigler–Najjar syndrome)
- Appropriate liver imaging (contrast versus non-contrast CT and MRI)
- Know indications and risks for liver biopsy
- Know indications and risks for liver transplant, including who to, when, and how to refer
- Know indications and risks for transjugular intrahepatic portosystemic shunt (TIPSS)/direct intrahepatic portacaval shunt (DIPS)/ balloon-occluded retrograde transvenous obliteration (BRTO)
- Liver fibrosis assessment, including non-invasive liver fibrosis tools
- Liver screening and surveillance for liver disease
- Portal hypertension assessment
- Drug-induced liver injury (DILI)
- Inherited and metabolic liver diseases
- Pregnancy-related liver disease, including management of pre-existing liver disease in pregnancy
