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 specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • 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)

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.

  • 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

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.