P93 Point of care focused acute medicine ultrasound (FAMUS) is useful the assessment of fluid status in patients with liver disease by specialists and generalists

<h3>Background</h3> Unplanned hospital admissions due to liver disease have increased by over 50% in England over the last decade,^{1 2} many of which will be initially assessed by non-hepatologists. Point of care ultrasound (POCUS) has been described for the assessment of patients with liver disease with ascites to guide sampling and drainage, and the evaluation of volume status in acute kidney injury and hepatorenal syndrome.^3–6 Focused Acute Medicine Ultrasound (FAMUS), comprising thoracic, abdominal/renal, vascular modules,⁷ is endorsed for the assessment of the acutely unwell medical patient. FAMUS accreditation is a recognised pathway towards achieving POCUS competencies, mandated by the acute internal medicine curriculum in the UK, and increasingly, generalist physicians will use FAMUS as part of routine clinical assessment.⁸ The use of FAMUS assessment in patients with liver disease has not previously been described. <h3>Methods</h3> FAMUS protocol scans on patients with liver disease between 29/4/2024 and 27/5/2025 were retrospectively identified at the Oxford University Hospitals NHS Foundation Trust, England. The indication for FAMUS and main imaging findings were recorded. <h3>Results</h3> FAMUS scans were undertaken at 86 timepoints on 58 patients with liver disease (67.2% male, median age 63, range 31–92) by 5 practitioners (4 generalists, 1 hepatologist). Scans were undertaken in inpatient (n=32, 37.2%), ambulatory (n=9, 10.5%) and hospital at home (n=45, 52.3%) settings. Most patients had cirrhosis with decompensation (n=54, 93.1%), due to alcohol (n=27,46.6%) or metabolic associated steatotic liver disease (n=13, 22.4%). The most common indication for FAMUS was for the assessment of ascites (n=53, 61.6%) or fluid status in acute kidney injury (n=18, 20.9%). Of the 86 FAMUS scans, the majority used the abdominal/renal module (n=85, 97.7%), which found ascites was present in 58 scans (67.4%) and hydronephrosis in 2 scans (2.3%). The FAMUS thoracic module was undertaken in 57 (65.5%) scans, of which 46 had bilateral A-line pattern (80.7%). Pleural effusions were detected on 11 scans (12.8%). Fourteen patients (24.1%) underwent serial scans at time intervals, to monitor response to therapeutic interventions. <h3>Conclusion</h3> FAMUS abdominal/renal and thoracic modules are used for the assessment of volume status in patients with liver disease by generalists and hepatologists. Major pathologies including pleural effusions, ascites and hydronephrosis can be identified and serial scans can be used to monitor response to therapy. Going forward, work to assess diagnostic accuracy of FAMUS in liver disease patients will enhance interpretation and support its incorporation into hepatology training. <h3>References</h3> Office for Health Improvement and Disparities. Liver disease profile, April 2024 update [Internet]. UK Government; 2024 [cited 2024 Oct 12]. Available from: https://www.gov.uk/government/statistics/liver-disease-profile-april-2024-update/liver-disease-profile-april-2024-update Bhala N, Subhani M, Aithal GP. Liver disease admissions in the UK are increasing, urgently needing local and national solutions. <i>Lancet Gastroenterol Hepatol.</i> 2023 Dec;8(12):1071. Premkumar M, Karvellas CJ, Kulkarni AV, Bhujade H, Reddy KR. Role of point-of-care ultrasound (POCUS) in clinical hepatology. <i>Hepatol Baltim Md.</i> 2024 Jul 1; Banegas-Deras EJ, Mazón-Ruiz J, Romero-González G, Ruiz-Cobo JC, Sanz-García C, Serrano-Soto M, <i>et al</i>. Acute kidney injury and point-of-care ultrasound in liver cirrhosis: redefining hepatorenal syndrome. <i>Clin Kidney J.</i> 2024 May;17(5):sfae112. Rendón-Ramírez EJ, González-Villarreal M, Muñoz-Espinoza LE, Colunga-Pedraza PR, Moreno JF, Salinas-Chapa M, <i>et al</i>. Pleural Effusions Identified by Point-of-Care Ultrasound Predict Poor Outcomes in Decompensated Cirrhosis. <i>Ultrasound Med Biol.</i> 2021 Nov;47(11):3283–90. Kajal K, Premkumar M, Chaluvashetty SB, Bhujade H, Kulkarni AV. Point-of-care thoracic ultrasonography in patients with cirrhosis and liver failure. <i>Cureus.</i> 2021 Jun;13(6):e15559. The Society for Acute Medicine. FAMUS focused acute medicine ultrasound curriculum pack [Internet]. The Society for Acute Medicine; 2020 [cited 2025 Jun 5]. Available from: https://www.acutemedicine.org.uk/download/famus-curriculum-pack/ Joint Royal Colleges of Physicians Training Board. Curriculum for Acute Internal Medicine [Internet]. Joint Royal Colleges of Physicians Training Board; 2022 [cited 2025 Jun 5]. Available from: https://www.thefederation.uk/sites/default/files/AIM%25202022%2520curriculum%2520FINAL%2520July%25202022_0.pdf