Top tips:

In all patients with compensated cirrhosis, assess whether the patient has clinically significant portal hypertension. If they do and there are no contraindications, consider starting carvedilol (or a non-selective beta-blocker) to reduce the risk of decompensation.
In those patients with compensated cirrhosis who are not already on carvedilol or a non-selective beta-blocker, a fibroscan score of >20 kPA OR a platelet count of <150,000 tells you the patient should be considered for endoscopy. If the fibroscan score is <20 kPA AND platelet count is >150,000 OR the patient is on carvedilol or a non-selective beta-blocker, screening endoscopy is not needed.
Patients with cirrhosis should undergo HCC surveillance with ultrasound and AFP every six months (notably, although by guidelines the AFP is optional, in our experience this is suggested)
Patients who have had a diagnosis of cirrhosis at anytime (regardless of whether they have improved or even cleared their Hepatitis B or C) should continue to undergo HCC surveillance

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- Compensated cirrhosis – Screening for liver related complications
- Decompensated cirrhosis – Screening for liver related complications
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Thank you to Dr. Ramji, Dr. Fung, and Dr. Burak for your efforts creating the content on this page. Check out the bottom of the page for a short video from Dr. Fung!

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Screening for liver related complications

Compensated cirrhosis

Defined by: the absence of ascites, hepatic encephalopathy, variceal bleeding or jaundice (see more info)

Screen-for-Complications-Algorithm-1

Decompensated cirrhosis

Defined by: the presence of ascites, hepatic encephalopathy, variceal bleeding or jaundice (see more info)

Screen-for-Complications-Algorithm-2

Introducing Dr. Ramji, Dr. Fung and Dr. Burak

Video 1 - Automating HCC surveillance - information about automatic recall ultrasound surveillance recall programs in Calgary and Edmonton.

Patient materials:

You can direct patients to the following:

HCC

Liver biopsy

Lab tests

Downloadable content:

You can download these to print or view offline:

Baveno guidelines 2021

AASLD Guidance 2018

EASL Clinical Practice Guidelines

References:

This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.

Authors: Michelle Carbonneau NP, Dr. Alnoor Ramji, Dr. Puneeta Tandon

References:

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018 Aug;69(2):406-460 PMID 29653741
de Franchis, R., Bosch, J., Garcia-Tsao, G., Reiberger, T., Ripoll, C., & Baveno VII Faculty (2022). Baveno VII – Renewing consensus in portal hypertension. Journal of hepatology, 76(4), 959–974. https://doi.org/10.1016/j.jhep.2021.12.022 PMID 35120736
EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018 Jul;69(1):182-236 PMID 29628281
Loomba R et al. AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology 2020 Jan 29 PMID 32006545

Last reviewed November 3, 2022

Screen for Complications