Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • gastrointestinal bleeding
  • acute liver failure
  • sepsis in a patient with cirrhosis
  • severe encephalopathy in a patient with liver disease
  • significant ascites requiring urgent paracentesis
  • acute kidney injury in a patient with cirrhosis

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 - appointment clinically indicated within 30 days

  • suspected or confirmed advanced fibrosis or cirrhosis with evidence of decompensated liver disease, including:
    • jaundice and/or
    • ascites and/or
    • encephalopathy
  • space occupying lesions

Category 2 — appointment clinically indicated within 90 days

  • suspected advanced fibrosis or cirrhosis without evidence of decompensated liver disease

Category 3 — appointment clinically indicated within 365 days

  • nil

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • for adult patients, relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • for paediatric patients, identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements


  • past medical/surgical history
  • family history of liver disease or diabetes
  • onset, duration, and progression of symptoms
  • current/previous medications and dosages, including supplements
  • use/frequency of alcohol, tobacco, and other drugs
  • allergies and sensitivities
  • management history including treatments trialled/implemented prior to referral
  • international travel, including locations and dates


  • abdominal examination results
  • features of hepatic failure, e.g. jaundice, ascites and/or encephalopathy
  • height/weight/body mass index (BMI)


  • complete blood examination (CBE)
  • liver function test (LFT)
  • urea, electrolyte, and creatinine (UEC)
  • iron studies
  • international normalised ratio (INR)
  • hepatitis B serology (HBV)
    • hepatitis B surface antigen
    • hepatitis B surface antibody
    • hepatitis B core antibody
  • hepatitis C serology (HCV): hepatitis C antibody with a request for pathology to reflexively test for HCV RNA if positive antibody result
  • alpha fetoprotein (AFP)
  • upper abdominal ultrasound (US)
  • antinuclear antibody test (ANA)
  • antimitochondrial antibody test (AMA)
  • smooth muscle antibody (SMA)
  • immunoglobulin G antibody (IgG)
  • ceruloplasmin levels
  • alpha-1 antitrypsin (AAT)
  • fasting blood glucose
  • glycated haemoglobin test (HbA1c)
  • lipid studies
  • haemochromatosis gene (HFE) test (if elevated ferritin and transferrin saturation)

Additional information to assist triage categorisation

  • liver elastography and/or other relevant imaging reports
  • previous endoscopic procedures (date and report)
  • previous pathology and investigations, including liver function tests (LFTs) and/or liver biopsy results

Clinical management advice

Optimisation of chronic medical conditions should be considered as part of initial assessment and management.

A variety of prescriptions, over-the-counter medications, herbal supplements, and occupational exposure to solvents and hydrocarbons can cause hepatotoxicity.

Screening and vaccination for hepatitis A and hepatitis B.

Lifelong disease monitoring will include regular hepatocellular cancer screening with 6-monthly liver ultrasound in suitable patients.

Category 3 referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but may not fit the criteria provided, you are encouraged to contact the specialist team to discuss your concerns.

Clinical resources

Consumer resources