North South North West Statewide

Pre-referral work-up


All referrals should comply to referral standards and include in particular:

  • Onset of symptoms
  • Past history including previous jaundice
  • Alcohol, smoking and illicit drug use
  • Overseas travel


Initial work up:

  • LFTs
  • Hepatocellular (elevated transaminases):
    • Viral serology: HAV, HBV, HCV, EBV, CMV
  • Abdominal Ultrasound if cholestatic (elevated ALP & GGT)
  • FBE
  • U&Es
  • If isolated raised bilirubin: haemolysis screen
  • Prothrombin time/INR
  • Immunoglobulins
  • Autoantibodies (SMA, AMA)
  • Clinical evidence of encephalopathy
    • Abdominal ultrasound
    • CT where appropriate

Interim/GP management

To refer a patient with this condition, please see the Gastroenterology clinic page for the full referral process and templates.

For more information please see the Tasmanian Health Pathways website.


Suspected acute, severe or fulminant hepatic failure

Direct referral to Emergency Department

Please contact Emergency Department Medical Officer in Charge via RHH switchboard 6166 8308

Urgent / category 1

When patient presents with any of the following, contact Gastroenterology Registrar via switch 6166 8308:

ALT>1000, abnormal INR, encephalopathy

Severe clinical or biochemical hepatocellular jaundice

Refer to Emergency Department OR Liver Clinic (depending on severity)

Obstructive jaundice (dilated ducts)

Semi-urgent / category 2

Unexplained non-obstructive cholestatic jaundice

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.


Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 8302  Fax: (03) 6777 5201
MCH ED – Phone: 0409 867 492  Fax: (03) 6441 5923
NWRH ED – Phone: 0459 848 725  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6101  Fax: (03) 6173 0489


We will endeavour to see these patients within four weeks

Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.


We will endeavour to see these patients within 12 weeks


Next available appointment