High blood-ammonia levels alone do not add any diagnostic, staging, or prognostic value in HE patients known to have chronic liver disease.
Lockwood AH. Blood ammonia levels and hepatic encephalopathy. Metab Brain Dis. 2004 Dec;19(3-4):345-9. PMID: 15554426.
Vilstrup H, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014 Aug;60(2):715-35. PMID: 25042402.Share on Facebook Share on Twitter
Routine tests of coagulation do not reflect bleeding risk in patients with cirrhosis and bleeding complications of these procedures are rare.
Northup PG, et al. Coagulation in liver disease: a guide for the clinician. Clin Gastroenterol Hepatol. 2013 Sep;11(9):1064-74. PMID: 23506859.
Tripodi A, et al. The coagulopathy of chronic liver disease. N Engl J Med. 2011 Jul 14;365(2):147-56. PMID: 21751907.
Yates SG, et al. How do we transfuse blood components in cirrhotic patients undergoing gastrointestinal procedures? Transfusion. 2016 Apr;56(4):791-8. PMID: 26876945.Share on Facebook Share on Twitter
Serum ferritin values reflect an increase in hepatic iron content and have a significant false positive rate because of elevations due to inflammation. Thus, in patients with evidence of liver disease, hemochromatosis genotyping should only be performed among individuals with an elevated ferritin and fasting transferrin saturation >45% (TSat) or a known family history of HFE-associated hereditary hemochromatosis.
Adams PC, et al. Hemochromatosis and iron-overload screening in a racially diverse population. N Engl J Med. 2005 Apr 28;352(17):1769-78. PMID: 15858186.
Bacon BR, et al. Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011 Jul;54(1):328-43. PMID: 21452290.Share on Facebook Share on Twitter
Patients with benign focal liver lesions who do not have underlying liver disease and have demonstrated clinical (asymptomatic) and radiologic stability do not need repeated imaging as the likelihood of evolving into neoplastic lesions is very low. In contrast, patients with radiologic evidence of hepatocellular adenoma may have an increased risk of complications and/or neoplasia thus warranting closer observation.
European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol. 2016 Aug;65(2):386-98. PMID: 27085809.
Marrero JA, et al. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014 Sep;109(9):1328-47; quiz 1348. PMID: 25135008.Share on Facebook Share on Twitter
Highly sensitive quantitative assays of hepatitis C RNA are appropriate at the time of diagnosis (to confirm infection) and as part of antiviral therapy, which is typically at the beginning and after therapy is completed to confirm sustained virological response at week 12 (SVR 12). Outside of these circumstances the results of virologic testing do not change clinical management or outcomes.
American Association for the Study of the Liver, Infectious Diseases Society of America. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C [Internet]. 2016 Jun [cited 2017 Mar 15].Share on Facebook Share on Twitter