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Abnormal liver function tests / jaundice

ADULT

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.


Potentially life threatening symptoms suggestive of

  • Acute severe GI bleeding
  • Acute liver failure
  • Sepsis in a patient with cirrhosis
  • Severe encephalopathy in a patient with liver disease
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Consider cessation of alcohol, hepatotoxic medication, herbal preparations, supplements, NSAIDs and benzodiazepines

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Abnormal liver function tests with ALT >500 and/or concerning features:
      • Evidence of liver decompensation i.e. jaundice and/or ascites and/or encephalopathy
  • Category 2
    (appointment within 90 calendar days)
    • Abnormal liver function tests +/- Low platelets and/or splenomegaly without concerning features

     

    NB Category 2 cases can be referred to local/regional general physician if gastroenterology access is not locally available

  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • General referral information
  • Alcohol and drug history
  • ELFT FBC results
  • HBV HCV serology results
  • Upper abdominal USS report
  • Height, weight and BMI

3. Additional referral information Useful for processing the referral

  • Family history of liver disease or blood disorders
  • Medication history including non-prescription medications, herbs, supplements, colloidal silver
  • Recent/past overseas travel
  • Occupational/chemical exposure
  • Record of previous liver function tests
  • Coeliac serology
  • Iron studies

4. Request

Patient's 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

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

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.)
  • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • 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.