Specialty: Gastroenterology
Age group: Adult
Direct to an emergency department for:
- Acute liver failure
- Severe hepatic encephalopathy
- Aspartate transaminase (AST) greater than 2,000 units per litre.
Criteria for referral to public hospital specialist clinic services
- Abnormal liver function tests with:
- platelet count less than 120 x 109per litre
- splenomegaly
- ascites
- hepatic encephalopathy
- genetic haemochromatosis (C282Y homozygotes and C282Y/H63D compound heterozygotes only)
- Abnormal liver function test with aspartate transaminase (AST) or alanine aminotransferase (ALT) greater than or equal to 5 times the upper level of the normal range
- Two abnormal liver function test results performed at least 3 months apart with aspartate transaminase (AST) or alanine aminotransferase (ALT) 2-5 times the upper level of the normal range.
Information to be included in the referral
Information that must be provided
- History of alcohol intake
- History of injectable drug use
- Current and historical liver function tests
- Full blood examination
- International normalised ration (INR) result
- Urea and electrolytes
- Upper abdominal ultrasound results
- Hepatitis B virus and Hepatitis C virus serology results
- History of diabetes
- Iron studies
- Current and complete medication history (including non-prescription medicines, herbs and supplements).
Provide if available
- Height, weight and body mass index
- Any relevant family history
- If symptoms are thought to be linked to probable or confirmed SARS CoV-2 (COVID-19) infection or Long COVID.
Additional comments
The Summary and referral information lists the information that should be included in a referral request.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
- Fatty liver with normal liver function tests.
Reviewed 30 May 2025