| 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
- Decompensated cirrhosis with red flags (e.g. jaundice, ascites) requiring inpatient management
- Severe alcoholic hepatitis requiring emergency department presentation
- High alanine aminotransferase (ALT) (>1000U/L) and clinically unwell
|
| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
|
- Suspected liver cancer/hepatocellular carcinoma
- Decompensated cirrhosis with red flags (jaundice, ascites) not requiring emergency department presentation
- Severe alcoholic hepatitis not requiring emergency department presentation
- High alanine aminotransferase (ALT) (>1000U/L) and clinically well
To contact the relevant service, see Clinician Assist WA: AcuteGastroenterology 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).
|
-
Abnormal liver function tests
|
| 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 diabetes
- Alcohol and illicit drug history
- Current medication list, including over the counter medication (e.g. herbal remedies)
- Any known allergies
|
| Examination |
- Height and weight, or BMI
|
| Investigations |
- FBC
- U&E
- LFT (including AST)
- HBV and HCV Serology
- Ferritin and transferrin saturation
- Upper abdominal ultrasound (US)
|
| Highly desirable |
| History |
- Family history of liver disease or blood disorders
- Recent/past overseas travel
|
| Examination |
|
| Investigations |
- INR
- Previous LFT
- Alpha fetoprotein (AFP)
- Liver screen bloods including autoantibodies
- Hypercholesterolaemia
- Hepascore or FibroScan or shear wave elastography (SWE) result
|
| Indicative clinical urgency category |
|
Category 1
Appointment within 30 days
|
-
Evidence of decompensated liver disease not requiring emergency department presentation or immediate referral
|
|
Category 2
Appointment within 90 days
|
- Abnormal LFT +/- Low Platelets and/or splenomegaly without red flags (i.e. evidence of liver decompensation e.g. jaundice, ascites)
- Compensated cirrhosis
|
|
Category 3
Appointment within 365 days
|
- LFT remain abnormal despite lifestyle measures
- Clinical concern that there is significant chronic liver disease
|
Feedback
If you would like to submit feedback on the contents of the Referral Access Criteria, please complete this form.
Last reviewed: 29-04-2025