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.
- suspected bowel obstruction – vomiting, significant distention, lack of passage of flatus, obstipation
- acute surgical pathology e.g. evidence of peritonism, systemic toxicity
- acute severe ulcerative colitis ≥ 6 bloody bowel stools per 24 hours (Truelove and Witts criteria) as well as any of the following:
- temperature > 37.8°C
- pulse rate > 90 bpm
- haemoglobin (Hb) < 105 g/l
- C-reactive protein (CRP) > 30mg/L at presentation or erythrocyte sedimentation rate (ESR) > 30 mm
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
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
Category 1 — appointment clinically indicated within 30 days
- abdominal pain with the following red flags:
- weight loss ≥ 10% in previous 3 to 6 months
- past history of intra-abdominal malignancy within the last 5 years
- iron deficiency or other abnormal blood tests (haemoglobin (Hb), C-reactive protein (CRP))
- abdominal mass on examination
- abnormal imaging
- nocturnal symptoms disturbing sleep
- positive immunological faecal occult blood testing (iFOBT )/faecal immunochemical test (FIT)/faecal human haemoglobin (FHH) - refer to 'Colorectal Cancer Screening - Adult CPC'
Category 2 — appointment clinically indicated within 90 days
- relevant family history of cancer
Category 3 — appointment clinically indicated within 365 days
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
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- detailed description of the abdominal pain including site, radiation, severity, character, pattern, precipitating or relieving factors, duration of symptoms, associated symptoms, functional impact
- presence or absence of red flags:
- progressive symptoms
- weight loss
- change in bowel habits
- bloody stools
- abdominal mass
- past relevant medical history, including past gastrointestinal (GI) cancer, abdominal surgery
- current medication especially nonsteroidal anti-inflammatory drugs, opioids, anti-depressants, selective serotonin reuptake inhibitors (SSRIs), anticoagulants, antiplatelets
- family history of GI disease in first degree relative – irritable bowel syndrome (IBS), cancer, polyp, inflammatory bowel disease (IBD)
- mental health and/or chronic pain issues
- drug and alcohol consumption
- examination findings – body mass index (BMI), abdominal and digital rectal examination (DRE)
- complete blood examination (CBE)
- urea, electrolytes, and creatinine (UEC)
- liver function tests (LFT)
- C-reactive protein (CRP), if IBD suspected
- iron studies
- faecal calprotectin if diarrhoea > 6 weeks
Additional information to assist triage categorisation
Previous investigations and reports of presenting abdominal pain, e.g. endoscopy, radiological reports.
Clinical management advice
Most abdominal pain is functional in nature or related to bloating, and constipation. This resolves with attention to diet, exercise and stress and often does not require specialist medical input.
It is always worth considering the possibility of pregnancy as a cause for symptoms.
Most cases where specialist review is indicated will be clearly identified by the presence of other red flags.
Abdominal pain alone is a low yield indication for colonoscopy, so unless there is a positive immunological faecal occult blood testing (iFOBT)/faecal immunochemical test (FIT)/faecal human haemoglobin (FHH), referrals for this indication are not likely to be accepted.
Category 3 referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician to discuss your concerns.
If a patient has been fully investigated within last 2 years and symptoms remain unchanged, clinician discretion is needed to appropriately refer and triage. In general, there is little value in repeat specialist assessment and/or endoscopic procedures in this scenario.
Refer to relevant CPC for:
- Overt Rectal Bleeding - Adult CPC
- Iron Deficiency with or without Anaemia - Adult CPC
- Altered Bowel Habits (Constipation and Diarrhoea) - Adult CPC
- Inflammatory Bowel Disease - Adult CPC