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 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

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

For more on outpatient referrals, see the general referral information page.

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.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • 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