Managing patients with advanced liver disease

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  • Determine the phase of the hepatitis B virus (HBV) infection.
  • Determine the severity of the liver disease.
  • Fully evaluate the patient to identify factors contributing to liver damage.
  • Minimise other hepatic injury:
    • manage other causes of liver disease or damage
    • advise on healthy living.
  • Offer antiviral therapy where appropriate – treat all cirrhotic patients with antiviral therapy.
  • Manage the complications of cirrhosis.
  • Implement screening for hepatocellular carcinoma as recommended in Hepatitis B related hepatocellular carcinoma.

Click to open recommendations

GESA Consensus Recommendation 10

GESA Consensus Recommendation 12

GESA Consensus Recommendation 18

GESA Consensus Recommendation 20

Clinical Practice Guidelines for HCC Recommendation

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  2. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatology 2017;67:370-98.
  3. Bajaj JS. Review article: the modern management of hepatic encephalopathy. Aliment Pharmacol Ther 2010;31:537–47.
  4. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology 2005;42:1208–36.
  5. Jairath V, Burroughs AK. Anticoagulation in patients with liver cirrhosis: complication or therapeutic opportunity? Gut 2013;62:479–82.
  6. Schiff ER, Sorrell MF, Maddrey WC. Schiff’s Diseases of the Liver (10th edition). Philidephia: Lippincott Williams & Wilkins; 2007.
  7. Sherlock S, Summerfield JA. A colour atlas of liver disease. London: Wolfe Medical Publications Ltd; 1979.
  8. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases.Hepatology 2017;65:310-35.
  9. Papatheodoridis G, Dalekos G, Yurdaydin C, Van Boemmel F, Buti M, Sypsa V, et al. Hepatocellular carcinoma (HCC) is the only factor affecting the excellent survival of Caucasian chronic hepatitis B (CHB) patients with or without cirrhosis under long-term entecavir (ETV) or tenofovir (TDF) therapy. Hepatology 2016;64 (Suppl):35A–36A.
  10. Heimbach JKulik LMFinn RSirlin CBAbecassis MRoberts LR,et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 2018;67:358-80.
  11. Cancer Council Australia Hepatocellular Carcinoma Surveillance Working Group. Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia. April 2023. Sydney: Cancer Council Australia.