​​​​​​​Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • acute liver failure (e.g. INR > 1.5 and encephalopathy or INR > 2, in the absence of pre-existing liver disease)
  • acute paracetamol toxicity (referral is indicated to paediatrician if no liver synthetic dysfunction)
  • chronic liver failure with fever or sepsis
  • jaundice with confusion
  • newborn with persistent (> 6 weeks), severe, recurrent unconjugated hyperbilirubinemia despite phototherapy (phone on-call gastroenterologist for advice)
  • post-transplant jaundice with fever or sepsis
  • sudden onset, obstructive jaundice.

When public outpatient services are not routinely provided

  • Hepatitis A with no coagulopathy that is able to have follow up in the community.
  • Sonographic fatty liver with normal liver function tests and normal liver and spleen size, in a child who has a weight and BMI > 85th centile as per age and sex appropriate centile chart. Child would benefit from dietitian or weight management referral in the first instance.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Newborn with persistent jaundice (> 2 weeks) with a conjugated fraction > 20% (with or without pale stools and/or dark urine). Presence of pale stools warrants an immediate contact to on-call gastroenterologist for advice.
  • Acute hepatitis with worsening liver function tests.
  • Chronic hepatitis.
  • Unexplained hepato-splenomegaly.
  • Unexplained cirrhosis.
Category 2
Recommended to be seen within 90 calendar days.
  • Liver lesion on ultrasound with normal liver function tests.
  • Liver disease treatment required that is outside the referrer’s scope of practice (for example, viral hepatitis, autoimmune liver disease, primary sclerosing cholangitis, Wilson’s disease, metabolic diseases).
  • Suspected steatotic liver disease or metabolic associated fatty liver disease (MAFLD).

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • use of nutritional supplementation and/or over the counter and herbal medicines
    • risk factors for viral hepatitis
    • liver function test results (current and previous)
    • full blood count (FBC)
    • coagulation profile
    • hepatitis A serology (HAV IgG)
    • hepatitis B serology (HBV sAg, sAb, cAb)
    • hepatitis C serology (HCV Ab)
    • iron studies
    • Epstein-Barr virus (EBV) and cytomegalovirus (CMV) serology
    • upper abdomen ultrasound.

If available

  • Alcohol intake (duration and quantity) (if relevant).
  • Vaccination history.
  • Any relevant family history.
  • Current body mass index, height, weight and other relevant growth parameters.
  • ‘Blue Book’, growth charts or any recent growth measurements.
  • HbA1c.
  • Creatine kinase (in presence of elevated transaminases).
  • Previous ultrasound, CT or MRI reports.
  • Additional pathology tests (for example, autoimmune hepatitis, Wilson’s disease, genetic disorders).
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ and/or among a vulnerable, disadvantaged or priority population.
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Sunday 12 May 2024
Contact page owner: System Purchasing