COVID-19: Hepatology service guide

May 2020

Scope

This information provides guidance on the management of Hepatology patients across Torbay & South Devon during the Covid-19 pandemic. The information is based on national guidance and local recommendations.

National guidance

British Society of Gastroenterology -COVID-19 Guidance and Advice

2WW referrals

  • Acute Jaundice requires urgent referral as usual
  • Please refer via the usual 2ww pathway or alternatively by contacting the Gastroenterologist of the Day phone, telephone: 07917071466, We recommend phoning between 09:00-12:00
  • Please note that access to services such as ERCP and EUS will be extremely limited. This means that unfortunately we will not be able to offer the standard diagnostic or management pathway in the majority cases

Conditions with specific guidance

Patients with liver disease in high risk group*:

`Shielded group` Advise mandatory self – isolation:

  1. Patients having undergone liver transplantation and taking immunosuppression and
  2. Patients with autoimmune hepatitis taking immunosuppression
  3. The consensus view in our specialty acknowledges the higher risk for patients with decompensated cirrhosis, who are not included in the shielding cohort. We recommend that these patients with decompensated cirrhosis should be advised to adhere strictly to social distancing measures in order to protect themselves.
Liver Transplantation

British Liver Transplantation Society COVID-19 resources

​Urgent referrals

Decompensated cirrhosis: ascites, hepatic encephalopathy, worsening jaundice, and suspected liver cancer all require urgent Hepatology opinion as usual.

Please consider contacting us for advice telephone: 07917071466 in the first instance to help direct these patients through the best pathway. We recommend phoning between 09:00-12:00.

​Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Routine referrals are not being allocated appointments at this time.

For anyone with mildly abnormal liver functions tests (LFT's) (ALT or ALP less than 300) please check Hepatitis B and C, Autoimmune liver screen, Immunoglobulins and request an US (if not had one since LFT's abnormal). If these do not show a significant abnormality please give lifestyle advice regarding alcohol, weight loss, diet and exercise. Please consider referring them in 6 months if their LFT's remain abnormal.

Below are links to Derriford's abnormal LFT and Fatty liver disease pathway which has already been uploaded and is very similar to our local guidance.

​Urgent advice

The Gastroenterology of the Day phone (07917071466) will still be in operation but with a reduced service. We recommend phoning between 09:00-12:00.

At times a non-clinician may be covering the phone and will take a message. It would be helpful to have a direct contact number to allow us to get back to you.

Covid 19 High risk patient advice

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 07-05-2020

 

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