Royal Liverpool Gastroenterology and Liver Services

Liver

Liver and Hepato-BiliaryServices

Liver Team

The Hepatology/Liver team at the Royal Liverpool University Hospital includes 5 Consultants, one Nurse Consultant, three middle grades doctors (Specialist Registrars), two Nurse Specialists, and a Hepatology Nurse (see tabe 1 below). There are also a team of Radiologists with a special interest in Hepatology as well as a Superintendent Radiographer with a specialist interest in ultrasound guided liver biopsy.

Table 1: The Liver Team

Clinician/Specialist	Job Title	Contact Details
Dr Paul Richardson	Consultant Hepatologist Clinical Lead - Hepatology	0151 706 3568
Dr Howard Smart	Consultant Gastroenterologist with interest in Hepato-Biliary Medicine	0151 706 3557
Prof Martin Lombard	Consultant Hepatologist	0151 706 3558
Dr Sanchoy Sarkar	Consultant Gastroenterologist with interest in Hepato-Biliary Medicine	0151 706 3554
Professor Sir Ian Gilmore	Consultant Hepatologist	0151 706 3558
Helen Caldwell	Nurse Consultant	0151 706 2805
Julie Barr	Nurse Specialist	0151 706 2453
Devina Mallon	Nurse Specialist	0151 706 2725
Steph Gray	Administrator	0151 706 2820

Out-Patient and In-patient Services

The outpatient services are shown in table 2 below. They consists of a joint ‘liver clinic’ involving 4 Medical Consultants, the Nurse Consultant, Specialist Nurse and three SpRs. There is a strong emphasis on standardized protocols and education. We accept referrals from primary, secondary and tertiary care. There are also three nurse led services, which include clinics for the treatment of viral hepatitis, haemachromatosis and long term chronic liver diseases. There are also pre-assessment clinics for patients undergoing procedures such as ERCP and ultrasound guided liver biopsy. A ‘virtual clinic’ is also undertaken by the Nurse Consultant and Specialist Nurse which involves pre-investigating all our new out-patient referrals to the liver team, allowing us to give a diagnosis, offer treatment or even discharge on the first appointment.

The Billary Sytem The Liver Service organises and performs all of the ERCP (~450pa) and EUS (~550 pa) within the Trust and works very closely with the surgical HPB unit and radiology. Approximately 100 patients are treated for hepatitis C per year and approximately 250 ultrasound guided liver biopsies are performed as day cases by either the Nurse Consultant in Hepatology or the Superintendent Radiographer. There are also approximately 140 patients with genetic haemachromatosis and approximately 15% require weekly venesections with the remaining 85% having three monthly venesections.

Care is also provided in a ward environment. This is a 24 bedded ward primarily caring for patient with hepatobiliary conditions, servicing the local community as well as offering a tertiary service for Merseyside, IOM, Lancashire, Cheshire & North Wales.

Table 2:Out Patient-Services

Clinic	Description	Lead	Contact Details
Liver Clinic	This is the main ‘Liver Clinic’ with 3 Medical Consultants, a Nurse Consultant, 3 SpRs and Specialist Nurse. All patients are pre-investigated before they attend the clinic and there is also an emphasis on standardized protocols and education.	Martin Lombard – Consultant Gastroenterologist	0151 706 3568
Viral Hepatitis Treatment clinic	Nurse led clinic offering treatment for patients with hepatitis C or B. This is a joint clinic with the specialist nurses in Infectious Diseases.	Helen Caldwell – Nurse Consultant	0151 706 2805
Chronic Disease Management clinic	Nurse led clinic for patients with chronic liver diseases such as PBC, autoimmune hepatitis who require management of their disease and monitoring of their immunosuppressant medication.	Helen Caldwell – Nurse Consultant	0151 706 2805
Transplant Clinic	Nurse led clinic for patients who have undergone a liver transplant. The clinic offers support for the patients as well as regular monitoring for side effects related to their immunosuppression medication.	Helen Caldwell – Nurse Consultant	0151 706 2805
Haemachromatosis Clinic	Nurse led service on the Gastroenterology Unit, offering counselling and screening of patients and their families with genetic haemachromatosis, as well as running a regular venesection programme.	Devina Mallon – Specialist Nurse	0151 706 2725
Pre-assessment clinic	This is a service that works along side the gastroenterology unit and the specialist nurses. Patients are assessed, consented and sent for necessary investigations prior to day case procedures such as ultrasound guided liver biopsy and ERCP.	Susan Williams – Hepatology Nurse	0151 706 2725
Pre-investigation Service	All out-patient referrals go through a system of pre-investigation prior to their clinic consultation. This involves arranging appropriate investigations as well as correlation of results.	Julie Barr – Hepatology Specialist Nurse	0151 706 2453
Ultrasound guided liver biopsy	Ultrasound guided liver biopsy performed in Interventional Theatres. These procedures are performed as day cases.	Helen Caldwell – Nurse Consultant	0151 706 2805
Adolescent Liver transitional Clinic	This clinic is run with the paediatric department for adolescent patients who will soon be transferring to the adult liver service.	Helen Caldwell – Nurse Consultant	0151 706 2805
Joint Viral Hepatitis / Haematology Clinic	Joint clinic with the Haematology department in the management & treatment of patients with hepatitis C and haemophilia.	Helen Caldwell – Nurse Consultant	0151 706 2805
Viral Hepatitis C clinic – Primary Care	Joint viral hepatitis treatment clinic with the local GP practice and the community hepatitis nurse.	Helen Caldwell – Nurse Consultant Jayne Wilkie – Hepatitis C nurse in Primary Care	0151 706 2805