Direct to an emergency department for:

  • Acute liver failure
  • Severe hepatic encephalopathy
  • Aspartate transaminase (AST) > 2,000 U/L.

Criteria for referral to public hospital specialist clinic services

  • Abnormal liver function tests with:
    • platelet count < 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) ≥ 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.