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 liver failure
  • encephalopathy with liver disease
  • gastrointestinal bleeding
  • haemodynamic instability

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

Category 1 (appointment clinically indicated within 30 days)

  • space occupying liver lesion confirmed with imaging
  • suspected malignancy

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • nil

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 specifically inflammatory bowel disease
    • history of previous cancer/s for example, colorectal cancer, gastric cancer
  • family history of liver disease/cancer/diabetes
  • current/previous medications and dosages, including supplements
  • use/ frequency of alcohol, tobacco, and other drugs
  • allergies and sensitivities
  • onset, duration, and progression of symptoms including features of hepatic failure, for example, jaundice, ascites and/or encephalopathy
  • management history including treatments trialled/implemented
  • Eastern Cooperative Oncology Group (ECOG) Performance Status
  • height/weight
  • body mass index (BMI)
  • abdominal examination
  • relevant imaging reports for example, quadruple-phase contrast multi detector computerised tomography (MDCT) scan to confirm or exclude hepatocellular carcinoma
  • relevant diagnostic/imaging reports including location of company and accession number

Pathology

  • complete blood examination (CBE)
  • liver function test (LFT)
  • electrolyes urea and creatinine (EUC)
  • 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)
  • HCV RNA (if positive antibody result)
  • cancer antigen (CA 19-9)
  • cancer embryonic antigen (CEA)

Additional information to assist triage categorisation

  • liver elastography and/or other relevant imaging reports

Clinical management advice

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

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.