​​​​​Emergency

If liver failure (bilirubin > 100, INR > 2.0) with clinical signs of decompensation is present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar.

When public outpatient services are not routinely provided

Fatty liver with normal liver function tests and Fibrosis-4 (FIB 4) score below 1.3 (meaning no significant fibrosis evident),

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Abnormal liver function tests if any of the following:
    • bilirubin > 34
    • albumin < 35
    • INR > 1.7 and/or platelets are outside normal range in setting of known or suspected liver disease (excluding unconjugated hyperbilirubinemia).
  • Abnormal liver function tests associated with new symptoms (e.g. nausea, anorexia) or ≥ 5% unexplained weight loss in past 1 month or ≥ 10% unexplained weight loss in past 6 months.
  • Persisting liver inflammation with ALT > 200 for more than a month.
  • New, abnormal liver function in a pregnant patient.
Category 2
Recommended to be seen within 90 calendar days.
  • Liver disease treatment required where outside the scope of the referrer scope of practice.
  • Metabolic syndrome or alcohol dependence suspected and non-invasive serological algorithm (Fibrosis-4 (FIB 4)) suggestive of cirrhosis (FIB 4 score above 3.5; a threshold where cirrhosis is likely), or elastography or radiologic evidence of cirrhosis.
Category 3
Recommended to be seen within 365 calendar days.
  • Metabolic syndrome associated liver function tests (LFTs) derangement suspected (MAFLD) and fibrosis indeterminate (FIB 4 score 1.3 – 3.5) where significant fibrosis and even cirrhosis is possible.
  • Abnormal LFTs and negative liver screen regardless of aetiology, severity or degree of work-up performed.
  • Fibrosis assessment requested (Fibro scan referral) when FIB 4 score above 1.3 (indeterminate), or known risk factors for chronic liver disease requiring monitoring (e.g. methotrexate, metabolic associated steatohepatitis, Hepatitis B).

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • alcohol intake (duration and quantity)
    • risk factors for viral hepatitis
    • full blood count or coagulation profile
    • HbA1c
    • iron studies
    • hepatitis A serology (HAV IgG)
    • hepatitis B serology (HBV sAg, sAb, cAb, and if HbsAg+, HBeAg/Ab and HBV DNA)
    • hepatitis C serology (HCV Ab, and if Ab+, HCV RNA)
    • liver function test results (current and previous)
    • upper abdomen ultrasound.

If available

  • Previous ultrasound, CT or MRI reports.
  • Elastography or other liver imaging.
  • Vaccination history.
  • Any relevant family history.
  • Additional pathology tests (for example, autoimmune hepatitis, primary biliary cirrhosis, Wilson’s disease, genetic disorders).
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ or among a vulnerable, disadvantaged or priority population.
  • If the patient is willing to have surgery (where clinically relevant).
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Sunday 12 May 2024
Contact page owner: System Purchasing