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.

  • acute lesion bleeding or rupture of lesion into the peritoneum
  • acute liver failure or associated liver impairment
  • severe encephalopathy in a patient with liver disease
  • sepsis in the presence of 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

  • space occupying liver lesion confirmed on imaging
  • suspected malignancy

Category 2 — appointment clinically indicated within 90 days

  • nil

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
  • history of previous cancer/s e.g. colorectal cancer, gastric cancer.
  • history of inflammatory bowel disease (IBD)
  • performance status or Eastern Cooperative Oncology Group (ECOG) measure


  • 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)
  • international normalised ratio (INR)
  • alpha fetoprotein (AFP)
  • 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 ribonucleic acid (RNA) if positive antibody result
  • cancer antigen (CA 19-9)
  • relevant imaging reports (i.e. quadruple-phase contrast multi detector computerised tomography (MDCT) scan to confirm or exclude an hepatocellular carcinoma (HCC))

Additional information to assist triage categorisation

  • liver elastography and/or other relevant imaging reports
  • family history of HCC
  • cancer embryonic antigen (CEA)

Clinical management advice

Please note that space occupying liver lesion referrals can be managed by the following specialist services:

  • hepatology
  • hepatopancreatic biliary (HPB) surgery

Clinical resources

Consumer resources