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 cholecystitis
  • cholangitis
  • obstructive jaundice with any of the following:
  • haemodynamic instability 
    • nausea and vomiting
    • pain/guarding
    • positive Murphy’s sign

Please contact the on-call registrar to discuss your concerns prior to referral.

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


  • asymptomatic gallstones
  • gall bladder polyps without deranged liver function tests (LFTs) less than 10mm on ultrasound 

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • frequent episodes of biliary colic (more than weekly) unrelieved with analgesia, and greater than 8 hours duration
  • confirmed common bile duct stones (imaging)

Category 2 (appointment clinically indicated within 90 days)

  • known gallstones with ongoing biliary colic
  • choledochal cyst
  • recurrent cholecystitis
  • gall bladder polyps greater than 11mm on imaging
  • porcelain (calcified) gallbladder wall

Category 3 (appointment clinically indicated within 365 days)

  • symptomatic gallstones including:
    • biliary pain
    • unintentional weight loss
    • jaundice
    • abnormal liver function test (LFTs)

For more on outpatient referrals, see the general referral information page.

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  
  • 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
  • interpreter requirements
  • past medical/surgical history
  • family history of biliary malignancy
  • medications and allergies
  • smoking/alcohol and other drug status
  • age
  • height/weight
  • body mass index (BMI)
  • history of presenting complaint
    • concerning features for example, nausea/vomiting, upper abdominal pain, post prandial symptoms, unintentional weight loss
    • duration/frequency/escalation of symptoms
    • previous management trialled and efficacy - including previous admission/s to hospital
  • abdominal examination findings such as
    • palpable gall bladder
    • right upper quadrant tenderness
  • pathology:
    • complete blood examination (CBE)
    • urea electrolytes and creatinine (UEC)
    • liver function test (LFT)
    • glycated haemoglobin (HbA1c) (diabetics)
    • c-reactive protein (CRP)
    • lipase/amylase – during episodic pain
  • abdominal ultrasound (US)
  • relevant diagnostic/imaging reports, including location of company and accession number

Additional information to assist triage categorisation

  • reports of prior gastroscopies and pathology results of specimens

Clinical management advice

There is no evidence to support the treatment for asymptomatic gallstones. Some factors that increase the risk of gallstone disease include:

  • obesity: carrying extra weight can make you more likely to develop gallstones because it raises cholesterol levels and increases the production of cholesterol-rich bile, which can lead to gallstone formation.
  • gender: women have a higher risk of developing gallstones compared to men. This is thought to be because of hormonal factors like estrogen, which can raise cholesterol levels in bile and reduce the movement of the gallbladder.
  • genetics: a family history of gallstones increases the likelihood of developing them
  • the risk of gallstone disease increases as you get older, especially after the age of 40.
  • losing weight quickly or following extreme low-calorie diets can increase the risk of gallstone formation.
  • medical conditions such as diabetes, liver cirrhosis, Crohn's disease, and metabolic syndrome can increase the risk of gallstone formation.
  • medications such as certain cholesterol-lowering drugs, and hormone therapies, such as estrogen replacement therapy, can contribute to the development of gallstones.

It is important to note that while these factors increase the risk of gallstone disease, not everyone with these risk factors will develop gallstones.

Clinical resources

Consumer resources