| 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 lesion(s) with evidence of active haemorrhage
- Associated with liver decompensation (e.g. jaundice, ascites, encephalopathy, variceal bleeding)
|
| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
|
- Liver lesion(s) on imaging suggestive of primary liver cancer (hepatocellular carcinoma (HCC) or cholangiocarcinoma)
- Symptomatic liver lesion(s)
- Rapidly enlarging liver lesion(s)
- Vascular invasion
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 lesion(s) as seen on imaging
|
| 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
- History of liver disease and/or previous cancer(s)
- History of diabetes
- Current medication list
- Any known allergies
|
| Examination |
- Height and weight, or BMI
|
| Investigations |
- FBC
- LFT
- Ultrasound (US) or MRI or CT of the abdomen
|
| Highly desirable |
| History |
- Family history of hepatocellular carcinoma (HCC)/cholangiocarcinoma
- Alcohol and illicit drug history
- Evidence of liver fibrosis/ cirrhosis
|
| Examination |
|
| Investigations |
- INR
- Alpha fetoprotein (AFP)
- HBV and HCV serology
- Other tumour markers - CA 19/9, CEA
- Multiphase MRI liver with contrast OR Multiphase CT liver with contrast (for solid liver lesion > 1cm)
|
| Indicative clinical urgency category |
|
Category 1
Appointment within 30 days
|
- Known chronic liver disease with:
- Liver lesion suggestive of primary liver cancer according to radiology report
- Raised alpha fetoprotein (AFP)
|
|
Category 2
Appointment within 90 days
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- Liver lesion(s) on imaging suggestive of benign liver lesion(s) requiring further characterisation
|
|
Category 3
Appointment within 365 days
|
- No defined category 3 criteria
|
| Exclusions |
- Haemangioma or focal nodular hyperplasia previously documented by either MRI or 2 forms of imaging
- Small (< 2cm) stable incidental haemangioma confirmed on 2 ultrasounds (US), 3 to 6 months apart, with no risk factors for liver disease
- For a solid liver lesion < 1cm, a repeat targeted US in 3 months before referring to outpatient services is required
- Reported simple liver cysts on imaging
- Gall bladder polyps
|
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Last reviewed: 29-04-2025