Liver disease is now the fifth leading cause of death in the UK but the good news is that liver disease is largely preventable and there is much we can do in primary care to educate people about the risks. This article explains the importance of identifying those patients who are at risk of liver disease, implementing risk reduction strategies, ensuring an accurate diagnosis is made and optimising ongoing management, including self-care strategies.
Holding out for a hero: helping patients to look after their livers
The liver is the body’s unsung hero, quietly working away to make the vital substances that keep a wide range of essential body processes ticking over, breaking down chemicals that would otherwise be toxic and hoovering up worn-out blood cells. But liver disease is currently very low on the primary care agenda compared to other long-term conditions such as cardiovascular disease, diabetes and respiratory conditions. Awarded ‘nil points’ on the Quality and Outcomes Framework (QOF), the liver doesn’t get a look in when it comes to health checks and dedicated clinics. So how can we make sure the liver isn’t left out of consultations?
Understanding viral hepatitis: as easy as A, B, C
Viral hepatitis is one of the three main causes of liver disease. We review the different types of viral hepatitis and the key steps in prevention, diagnosis and treatment.
When and how to use liver function tests
Why bother checking a patient’s liver function? We look at when and how to use liver function tests in clinical practice.
Making sense of liver function tests
The liver has many functions, and therefore diseases of the liver have numerous consequences. These can be detected and monitored with blood tests. This article provides a review of liver function tests, or LFTs, and how they relate to the key functions of the liver and some of the most common liver diseases.
Reducing alcohol misuse and using audit tools in primary care
Excessive alcohol consumption has joined smoking and obesity as one of today’s major threats to public health. It is a major cause of liver disease, as well as a range of cancers, cardiovascular disease and mental illness. What’s the solution? We look at how primary care can identify patients who are drinking too much and what interventions can help.
British Heart Foundation – New support for GPs
The British Heart Foundation (BHF) is often seen as an organisation focused on patients. This is true, but along with major research, supporting healthcare professionals is also a vital part of our role. In the past we have worked mainly with specialists in secondary care, but now we are re-focusing our attention. For the first time, we are supporting GPs and other primary healthcare professionals with education and training, and becoming involved in projects where GPs play a central role in improving patient outcomes.
Chronic kidney disease: an increasingly recognised marker of cardiovascular risk
Richard Bright was ahead of his time in recognising the importance of being able to diagnose renal disease. Chronic kidney disease (CKD) patients can be at similar levels of cardiovascular risk to those patients who have previously had a heart attack.
Stroke and cardiovascular disease: significant progress but still much to do
In March 2012, the Department of Health created the first National Clinical Director post dedicated to stroke care. Whilst the post is an interim one, pending final decisions about the nature of clinical input to the NHS Commissioning Board from 1st April 2013, its creation emphasises the commitment of the government to continue the implementation of the National Stroke Strategy, in the context of a major emphasis on joining up cardiovascular care.
Be aware: signposting acute chest pain
The Mid and South West Wales Cardiac Network (now the South Wales Cardiac Network) identified the need to devise resources to encourage patients to dial 999, safely signposting those calling into a GP practice complaining of acute chest pain to the 999 system. The resources and educational sessions were well received, with outcomes demonstrating improvements in staff confidence, backed up with the rationale and guidance, and an improvement in those directly accessing the 999 system, with the potential to receive reperfusion more quickly, preserving myocardium.
The GRANITE project: evaluating a novel cardiovascular prevention model in Scotland
Targeted case-finding for cardiovascular disease (CVD) prevention may be preferable to universal screening. Quality Improvement Scotland (QIS) has recommended that identification of high-risk individuals is needed. In this study, probable CVD risk in patients within the 40-70 years age range who were not on the CHD, Diabetes and Stroke registers and who were not already receiving statins was analysed using a predictive software toolkit which utilised the ASSIGN risk calculator. This programme effectively identified a patient population with a probable high 10-year CVD risk requiring intervention for CVD prevention after clinical assessment.
The varicose vein consultation: an aide-mémoire
Varicose veins affect about 25% of adults in the UK,1 with roughly equal prevalence in men and women, although women are more likely to present. Approximately 50% of varicosities involve the great saphenous vein (GSV), 30% the short saphenous vein (SSV), and 20% both.2 Patients may present to primary care with aesthetic concerns, or with symptoms including night cramps, itching, mild swelling of the ankles or a dull ache in the legs (usually exacerbated by standing for long periods and worse at night). The motivation for presentation should be sought as this will guide your management strategy.3 Varicosity size may not correlate with the severity of symptoms as reported by the patient.
