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 lesion bleeding or rupture of lesion into the peritoneum
  • acute liver failure or associated liver impairment
  • severe encephalopathy in a patient with liver disease
  • sepsis in the presence of cirrhosis

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

  • space occupying liver lesion confirmed on 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.

History

  • 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
  • history of previous cancer/s e.g. colorectal cancer, gastric cancer.
  • history of inflammatory bowel disease (IBD)
  • performance status or Eastern Cooperative Oncology Group (ECOG) measure

Examination

  • abdominal examination results
  • features of hepatic failure, e.g. jaundice, ascites and/or encephalopathy
  • height/weight/body mass index (BMI)

Investigations

  • complete blood examination (CBE)
  • liver function test (LFT)
  • urea, electrolyte, and creatinine (UEC)
  • 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): hepatitis C antibody with a request for pathology to reflexively test for HCV ribonucleic acid (RNA) if positive antibody result
  • cancer antigen (CA 19-9)
  • relevant imaging reports (i.e. quadruple-phase contrast multi detector computerised tomography (MDCT) scan to confirm or exclude an hepatocellular carcinoma (HCC))

Additional information to assist triage categorisation

  • liver elastography and/or other relevant imaging reports
  • family history of HCC
  • cancer embryonic antigen (CEA)

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.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.