| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
- Liver failure (rapid decline in hepatic function in patients) with red flags which include:
- jaundice
- ascites
- hepatic encephalopathy
- haematemesis (e.g. variceal bleeding)
- Sepsis in a patient with cirrhosis
- Spontaneous bacterial peritonitis
- Severe ascites restricting movement and breathing or causing abdominal pain
|
| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
|
- Deteriorating LFT (e.g. rising bilirubin, alanine aminotransferase (ALT) and/or INR) without red flags
To contact the relevant service, see Clinician Assist WA: Acute Gastroenterology assessment (external site)
|
| Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
|
- Liver cirrhosis as seen on imaging
- Clinical signs of cirrhosis and/or portal hypertension
|
| Mandatory information |
|
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
|
| History |
- Relevant history, onset, duration, and severity of symptoms
- Alcohol and illicit drug history
- Current medications list
- Any known allergies
|
| Examination |
- Height and weight, or BMI
|
| Investigations |
- FBC
- U&E
- INR
- LFT (including AST)
- HBV and HCV serology
- Fe studies
- Upper abdominal ultrasound (US) and/or contrast-enhanced CT
|
| Highly desirable |
| History |
- Relevant past medical history
- Family history of liver cancer or other liver disease(s)
- Previous endoscopic procedures (date and report)
|
| Examination |
|
| Investigations |
- FIB-4 or Hepascore
- Previous LFT (including AST)
- Alpha Fetoprotein (AFP)
- Previous liver screen results including autoantibody, viral serology etc
- Liver elastography
- Relevant imaging reports (look for key words e.g. liver surface nodularity, splenomegaly, dilated portal vein, ascites)
- Previous liver biopsy results
|
| Indicative clinical urgency category |
|
Category 1
Appointment within 30 days
|
-
Decompensated cirrhosis not requiring emergency department presentation
|
|
Category 2
Appointment within 90 days
|
- Suspected fibrosis or cirrhosis without red flags (compensated cirrhosis)
- Known cirrhosis for ongoing monitoring
|
|
Category 3
Appointment within 365 days
|
- No defined category 3 criteria
|
| Useful information |
- Screening and vaccination for hepatitis A
- Screening and vaccination for hepatitis B
- Patients with advanced fibrosis/cirrhosis require lifelong monitoring of disease for hepatocellular cancer screening with 6-monthly ultrasound (US) and alpha fetoprotein (AFP)
|
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Last reviewed: 29-04-2025