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/fulminant liver failure
  • sepsis in a patient with cirrhosis
  • encephalopathy in a patient with liver disease

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

  • abnormal liver function tests (LFTs) with evidence of decompensated liver disease, including:
    • jaundice and/or
    • ascites and/or
    • encephalopathy
    • for paediatric patients, contact Women’s and Children’s Hospital (WCH) registrar on-call on (08) 8161 7000 for advice or to escalate and discuss any clinical concerns
  • newly diagnosed autoimmune liver disease with elevated alanine transaminase (ALT) (>5 times upper limit of normal)
  • abnormal LFTs with significantly elevated liver enzymes

Category 2 — appointment clinically indicated within 90 days

  • abnormal liver function tests +/- low platelets and/or splenomegaly without decompensation
  • abnormal ferritin and transferrin saturation

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


  • 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)
  • fasting blood glucose
  • glycated haemoglobin test (HbA1c)
  • lipid studies
  • 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
  • antinuclear antibody test (ANA)
  • antimitochondrial antibody test (AMA)
  • smooth muscle antibody (SMA)
  • immunoglobulin G antibody (IgG)
  • haemochromatosis gene (HFE) test (if elevated ferritin and transferrin saturation)
  • ceruloplasmin levels
  • upper abdominal ultrasound (US)

Additional information to assist triage categorisation

  • Liver elastography and/or other relevant imaging reports
  • other relevant investigations undertaken (e.g. perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA), copper levels)

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, and herbal supplements can cause hepatotoxicity through a variety of mechanisms.

Consider referral for mildly persistent abnormal liver function test (LFTs)- 2 tests that are 3 to 6 months apart.

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