Obstructive Liver Disease - Paediatric CPC

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

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Category 1 - appointment clinically indicated within 30 days

• conjugated serum bilirubin (SBR) > 20% two weeks post-partum

Category 2 — appointment clinically indicated within 90 days

• nil

Category 3 — appointment clinically indicated within 365 days

• nil

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.

History

• past medical/surgical history, including cardiac 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
• child/parent demographic information, including best contact details
• antenatal course
• birth history e.g. gestational age, birth trauma, instrumental delivery
• feeding history e.g. breast/formula/nasoenteric feeding

Examination

• abdominal examination results
• height/weight, including any weight loss
• output (urine/stools) e.g. hydration status, dark urine and pale stools

Investigations

• total serum bilirubin (SBR):
  • unconjugated (indirect)
  • conjugated (direct)
• complete blood examination (CBE)
• direct antiglobulin test (Coombs)
• neonatal blood group
• maternal blood group and antibodies titres
• liver function test (LFT)
• glycated haemoglobin test (HbA1c) OR blood glucose level (BGL)
• thyroid function test (TFT)
• c-reactive protein (CRP)
• maternal infectious serology
• ultrasound (lesion) report (US), if gall bladder involvement suspected

Additional information to assist triage categorisation

• liver elastography and/or other relevant imaging reports
• urine culture may be indicated where there is faltering growth but is not a routine test in prolonged jaundice

Clinical management advice

With current standards of perinatal care the great majority of babies who develop clinically significant jaundice will do so after discharge from hospital.

Prematurity, weight loss due to inadequate breast milk intake, and lack of recognition of jaundice leading to delays in presentation and treatment are common factors described in cases of kernicterus.

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

• Royal Children’s Hospital – Jaundice in Early Infancy
• SA Health – Neonatal Jaundice (PDF 1866KB)

Consumer resources

• Betterhealth – Jaundice in Babies
• Pregnancy Birth Baby – Jaundice in Babies
• Children’s Liver Disease Foundation

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• full name, including aliases
• date of birth
• residential and postal address
• telephone contact number/s – home, mobile and alternative
• Medicare number, where eligible
• name of the parent or caregiver, if appropriate
• preferred language and interpreter requirements
• identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

• impact on employment
• impact on education
• impact on home
• impact on activities of daily living
• impact on ability to care for others
• impact on personal frailty or safety
• identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery, where surgery is a likely intervention.
• Choice to be treated as a public or private patient.
• Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
• Relevant social history, including identifying 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.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.