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Gastroenterology and Hepatology referral guidelines - public patients

Purpose

This page contains information on how to refer patients aged 16 years and over to Gastroenterology and Hepatology services at Mater Hospital Brisbane.

Service availability 

 

The Gastroenterology and Hepatology service at Mater Hospital Brisbane offer day procedure and outpatient clinics services. This service also offers a specialised young adult service for eligible patients aged between 16 and 25 years at Mater Young Adult Health Centre Brisbane. The Gastroenterology and Hepatology Service is comprised of medical specialists, a Hepatology Nurse Practitioner, an IBD Clinical Nurse Consultant and  specialised Clinical Nurses. Patients also have access to allied health services including physiotherapy, psychology, social work, occupational therapy and dietetics. 

Specialised clinics are available for patients with 

  • Chronic liver disease, such as Hepatitis B and Hepatitis C Viruses
  • Inflammatory Bowel Disease

How to Refer

If referral for care is indicated please list all of the General Referral Information and reason for request, and essential information as indicated below.

To refer, please fill in the Mater Adult Referral Form, available to download and embed into most major Practice Management software applications.

Referrals can be sent by:

Secure messaging  Medical Objects:   HM4101000R8
  HealthLink EDI:    materref   
Fax    07 3163 8548

 

 

 

 

Emergency

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region:

 

View list of conditions:

  • Potentially life threatening symptoms suggestive of:
    • acute upper GI tract bleeding
    • acute severe lower GI tract bleeding
    • oesophageal foreign bodies/food bolus
    • Acute Severe Colitis**
  • abdominal sepsis
  • bowel obstruction
  • Severe vomiting and/or diarrhoea with dehydration
  • Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
  • Biliary sepsis (to be referred to a centre with ERCP service)
  • Acute severe GI bleeding
  • Acute liver failure
  • Sepsis in a patient with cirrhosis
  • Severe encephalopathy in a patient with liver disease

In case of Endoscopy:

Potentially life threatening symptoms suggestive of:

  • acute upper GI tract bleeding
  • acute severe lower GI tract bleeding
  • oesophageal foreign bodies/food bolus
  • Acute Severe Colitis**
  • Bowel obstruction
  • abdominal sepsis

Displaced gastrostomy tube

Severe vomiting and/or diarrhoea with dehydration

 

**Acute severe colitis is defined by Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

  • Haemoglobin at presentation of < 105gm/l, CRP >20mg/dl at presentation (or ESR > 30mm/hr)
  • Pulse rate at presentation of > 90bpm
  • Temperature at presentation > 37.8°C

 

Scope of Service

Conditions out of scope

The following conditions are not routinely provided at Mater Hospital Brisbane:

View list of conditions:

  • Screening colonoscopy in asymptomatic patients outside of the NHMRC guidelines

 

Gastroenterology 

Conditions in scope

Abdominal Pain

Essential information (Referral will be declined without this)

  • General referral information
  • Patient and family history of gastrointestinal cancer
  • Previous endoscopic procedures (date, report and histology)
  • ELFT FBC iron studies U&E results
  • Relevant imaging reports

Additional referral information (useful for processing the referral)

  • No additional information 

Other useful information for management (not an exhaustive list)

  • Refer to Health Pathways or local guidelines

NB: If the patient who has  been fully investigated 2 years prior to referral, then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

  • Severe abdominal pain with significant impact on activities of daily living and with the following concerning features:
  • Weight loss ≥5% of body weight in previous 6 months
  • Past history Barrett’s/polyps/cancer
  • Patient and family history of Barrett’s, oesophageal or gastric or bowel cancer
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • Abdominal mass on clinical examination or abnormal imaging
  • Abdominal pain for >6 weeks without concerning features and not affecting activities of daily living 
  • No category 3 criteria 

 

Altered bowel habit

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Relevant imaging reports (e.g. pelvic USS)
  • CA125
  • Faecal calprotectin
  • Faecal immunochemical test (FIT)

Other useful information for management (not an exhaustive list)

  • Refer to Healthpathways or local guidelines
  • Consider referring to a dietitian e.g. Fermentable oligo -, di-, mono-saccharides and polyols (FODMAP) diet

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management

Progressive or persistent symptoms with concerning features

 

  • Bloody or nocturnal diarrhoea
  • Weight loss, ≥5% of body weight in previous 6 months
  • Persistent abdominal pain
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • Abnormal imaging
  • Patient and family history of bowel cancer or inflammatory

Progressive or persistent symptoms despite medical management without concerning features

No category 3 criteria

 

Barrett's oesophagus surveillance

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • No additional information 

Other useful information for management (not an exhaustive list)

Australian clinical practice guidelines for the diagnosis and management of Barrett's oesophagus and early oesophageal adenocarcinoma (2015) recommended screening endoscopy schedules:

 

No dysplasia on endoscopic assessment and Seattle protocol biopsy

  • Short (< 3 cm) segment – repeat endoscopy in 3–5 years
  • Long (≥ 3 cm) segment – repeat endoscopy in 2–3 years

If there has been previous low-grade dysplasia, see low-grade dysplasia protocol.

Seattle protocol—biopsy of any mucosal irregularity and quadrantic biopsies every 2 cm unless known or suspected dysplasia then quadrantic biopsies every 1 cm.

Indefinite for dysplasia on biopsy

The changes of indefinite for dysplasia on biopsy should be confirmed by a second pathologist, ideally an expert gastrointestinal pathologist. If indefinite for dysplasia is confirmed, then the following endoscopic surveillance is recommended:

  • Repeat endoscopy in 6 months with Seattle protocol biopsies for suspected dysplasia (biopsy of any mucosal irregularity and quadrantic biopsies every 1 cm) on maximal acid suppression
  • If repeat shows no dysplasia, then follow as per non-dysplastic protocol
  • If repeat shows low-grade or high-grade dysplasia or adenocarcinoma, then follow protocols for these respective conditions
  • If repeat again shows confirmed indefinite for dysplasia, then repeat endoscopy in 6 months with Seattle protocol biopsies for suspected dysplasia.

Low-grade dysplasia on biopsy

The changes of low-grade dysplasia on biopsy should be confirmed by a second pathologist, ideally an expert gastrointestinal pathologist. If low-grade dysplasia is confirmed, then the following endoscopic surveillance is recommended (or refer to an expert centre for assessment):

  • Repeat endoscopy every 6 months with Seattle protocol biopsies for dysplasia (biopsy of any mucosal irregularity and quadrantic biopsies every 1 cm.
  • If 2 consecutive 6-monthly endoscopies with Seattle dysplasia biopsy protocol show no dysplasia, then consider reverting to a less frequent follow up schedule.

High-grade dysplasia or adenocarcinoma on biopsy

Referral to a centre that has integrated expertise in endoscopy, imaging, surgery and histopathology

Refer to Healthpathways or local guidelines

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

See other useful information for referring practitioners

See other useful information for referring practitioners)

See other useful information for referring practitioners

 

Bowel cancer screening

Essential information (Referral will be declined without this)

  • General referral information
  • Patient and family history of bowel cancer
  • U&E
  • Previous endoscopic procedures (date, report and histology)
  • For NBCSP patients with positive FOBt - include NBSCP pathology report / ID number

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

iFOBT positive in patients > 50 years old

No category 2 criteria

  • Family history of colorectal cancer  (CRC) in patients with one first-degree relative diagnosed with CRC <55 years, or two first- or second-degree relatives (on the same side of the family) diagnosed with CRC at any age
  • Multiple bowel cancers

 

Coeliac disease

Essential information (Referral will be declined without this)

NB If patients are on a gluten-free diet, advise them to add gluten to their diet for four weeks before diagnostic testing

 

Additional referral information (useful for processing the referral)

  • TSH Vitamin B12 Folate 25-OH Vitamin D results

Other useful information for management (not an exhaustive list)

  • Refere to Healthpathways or local guidelines
  • Consider the following:
    • refer to a dietitian
    • monitor for diet compliance with coeliac disease serology every 6 to 12 months
    • screen family members with serology
    • baseline bone mineral densitometry
    • monitor for other auto-immune disorders

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Positive coeliac serology with concerning features

Presence of concerning features

  • Bloody or nocturnal diarrhoea
  • Weight loss, ≥5% of body weight in previous 6 months
  • Persistent abdominal pain
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women

Positive coeliac serology without red flags

No category 3 criteria

 

Constipation

Essential information (Referral will be declined without this)

  • General referral information
  • FBC TSH iron studies results
  • Serum calcium results
  • Medical management to date (document treatments offered and efficacy including failed dietary/pharmocology intervention)

Additional referral information (useful for processing the referral)

  • Relevant imaging reports (e.g. CT abdomen)

Other useful information for management (not an exhaustive list)

  • Refer to Healthpathways or local guidelines
  • Consider the following:
    • refer to a dietician
    • bowel outlet obstruction
    • physiotherapist management of pelvic floor dysfunction

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

New onset constipation in patients > 50 years old or patients with any of th efollowing concerning features

  • Gastrointestinal bleeding
  • Abdominal pain/mass
  • Family history of bowel cancer
  • Weight loss ≥5% of body weight in previous 6 months
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women

Refractory symptoms not responding to medical management without concerning features and affecting activities of daily living

No category 3 criteria

 

Diarrhoea

Essential information (Referral will be declined without this)

  • General referral information
  • Patient and family history of gastrointestinal cancer
  • ELFT FBC TSH iron studies results
  • Coeliac disease serology results
  • Stool test results
  • Previous gastrointestinal investigations and results (date and report)

Additional referral information (useful for processing the referral)

  • CRP, Faecal calprotectin, if inflammatory bowel disease is suspected
  • Faecal immunochemical test (FIT) 
  • Relevant imaging reports
  • Clostridium difficile toxin (if recent antibiotics)
  • Recent travel history

Other useful information for management (not an exhaustive list)

  • Consider referral to a dietician or for faecal incontinence
  • Refer to Healthpathways or local guidelines

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Diarrhoea > 6 weeks that is affecting activities of daily living and with any of the following concerning features:

  • Bloody or nocturnal diarrhoea
  • Weight loss, ≥5% of body weight in previous 6 months
  • Persistent abdominal pain
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • Patient and family history of bowel cancer or inflammatory bowel disease

Diarrhoea > 6 weeks without concerning features

No category 3 criteria

 

Dyspepsia/ heartburn/ refulx

Essential information (Referral will be declined without this)

  • General referral information
  • Family history of gastrointestinal cancers
  • FBC, iron studies results
  • Medical management to date (document treatments offered and efficacy including failed treatment with moderate dose PPI for dyspepsia)

Additional referral information (useful for processing the referral)

  • Previous endoscopic procedures (date and report)
  • Relevant imaging reports
  • H pylori results

Other useful information for management (not an exhaustive list)

  • Refer to the Healthpathways or local guidelines.

Consider the following:

  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Treatment if H pylori present
  • Cease any aggravating medications if possible e.g. NSAIDS, aspirin
  • Antacid therapies
  • Other evidence based therapies (e.g. prokinetics)

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Any patient with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) with any of the following concerning features:

  • Gastrointestinal bleeding
  • Weight loss, ≥5% of body weight in previous 6 months
  • Difficulty swallowing
  • Persistent vomiting
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women

Any patient with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) without concerning features

No category 3 criteria

 

Dysphagia (Gastroenterology)

Essential information (Referral will be declined without this)

  • General referral information
  • History of presenting complaint:
    • difficulty or pain on swallowing
    • food or liquids are stuck in throat or chest
    • pain or pressure in chest associated with swallowing
    • loss of appetite/food avoidance associated with swallowing difficulty
  • FBC iron studies results

Additional referral information (useful for processing the referral)

  • Relevant imaging reports
  • Atopy

Other useful information for management (not an exhaustive list)

  • Refer to Healthpathways or local guidelines

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Significant dysphagia

No category 2 criteria

No category 3 criteria

 

Inflammatory bowel disease

Essential information (Referral will be declined without this)

  • General referral information
  • ELFT FBC iron studies results
  • CRP results
  • Vitamin B12, 25-OH vitamin D results
  • Stool M/C/S and PCR including Clostridium difficile (Category 1 referrals only)
  • Relevant imaging reports

Additional referral information (useful for processing the referral)

  • Faecal calprotectin

Other useful information for management (not an exhaustive list)

  • Refer to Health pathways or local guidelines
  • Smoking cessation is likely to reduce disease activity in Crohn's disease

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Previously diagnosed or suspected inflammatory bowel disease with any of the following concerning features:

  • Rectal bleeding
  • Symptoms of bowel obstruction
  • Fever and/or abdominal / perineal mass
  • Significant bloody diarrhoea ≥6x/day
  • Weight loss ≥5% of body weight in previous 6 months
  • Significant abnormalities in investigations i.e. Hb <100 g/l, CRP >20mg/dl or faecal calprotectin >200 mcg/g

Stable previously diagnosed inflammatory bowel disease without concerning features

Monitoring and/or bowel cancer screening colonoscopy

 

Iron deficiency

Essential information (Referral will be declined without this)

  • General referral information
  • Family history of gastrointestinal cancer
  • ELFT FBC iron studies results
  • Coeliac disease serology results
  • Menstrual history

Additional referral information (useful for processing the referral)

  • Dietary history
  • Urine dipstick results

Other useful information for management (not an exhaustive list)

  • Refer to Healthpathways or local guidelines
  • Consider referral to a dietitician 

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Iron deficiency anaemia or iron deficiency with any of the following concerning features

  • no obvious cause
  • persisting despite correction of potential causative factors
  • Weight loss ≥5% of body weight in previous 6 months

Iron deficiency without any concerning features

No category 3 criteria

 

Polyp surveillance

Essential information (Referral will be declined without this)

  • General referral information
  • Relatives diagnosed with FAP
  • Relatives diagnosed with HNPCC
  • Family or personal history of colorectal cancer
  • Previous endoscopic procedures (date, report and histology)

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

Refer to Healthpathwyas or local guidelines

NHMRC Clinical Practice Guideline (2011) recommended screening colonoscopy schedules for polyp surveillance

  • 5 yearly – If < 3 polyps (excluding diminutive rectosigmoid hyperplastic polyps) provided that all polyps are ‘simple’ as defined by dimensions (<10mm) and histopathology (no high-grade dysplasia or villous change)
  • 3 yearly – If > 3 polyps (excluding diminutive rectosigmoid hyperplastic polyps) or if one or more polyps are ‘advanced’ as characterised by dimensions (≥10mm) and/or histopathology (presence of high-grade dysplasia or villous change)
  • Annual – If 5 to 9 polyps (excluding diminutive rectosigmoid hyperplastic polyps)
  • <12 months – If required, a baseline colonoscopy may need to be repeated in cases of poor bowel preparation (immediate rescheduling), possible incomplete excision of a large polyp (often at 3 months) or the presence of multiple adenomas (≥10) to ensure complete clearance

NB patients with Familial Adenomatous Polyposis (FAP) and Lynch syndrome (HNPCC) need punctual surveillance due to the high-risk nature of these conditions.

NB: If a patient who has been fully investigated 2 years prior to referral. Then the referrer and receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy/colonoscopy procedures.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

See other useful information for referring practitioners

See other useful information for referring practitioners

See other useful information for referring practitioners)

 

Rectal bleeding

Essential information (Referral will be declined without this)

  • General referral information
  • Patient and family history of gastrointestinal cancer
  • Documented duration, age of onset and associated symptoms
  • FBC iron studies U&E results
  • Previous gastrointestinal investigations and results (date and report)
  • Rectal examination result

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • Refer to Healthpathways or local guidelines
  • If patient has haemorrhoids and no mass on DRE, refer if bleeding is recurrent or persists > 6 weeks

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Rectal bleeding with any of the following concerning features:

  • Dark blood coating or mixed with stool
  • Weight loss, ≥5% of body weight in previous 6 months
  • Abdominal / rectal mass
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • Patient and family history of bowel cancer (1st degree relative <55 years old)

Rectal bleeding without concerning features

No category 3 criteria 

 

 

Hepatology

Conditions in scope

Abnormal liver function tests/ jaundice

Essential information (Referral will be declined without this)

  • General referral information
  • Alcohol and drug history
  • ELFT FBC results
  • HBV HCV serology results
  • Upper abdominal USS report
  • Height, weight and BMI

Additional referral information (useful for processing the referral)

  • Family history of liver disease or blood disorders
  • Medication history including non-prescription medications, herbs, supplements, colloidal silver
  • Recent / past overseas travel
  • Occupational / chemical exposure
  • Record of previous liver function tests
  • Coeliac serology
  • Iron studies

Other useful information for management (not an exhaustive list)

  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Consider cessation of alcohol, hepatotoxic medication, herbal preparations, supplements, NSAIDs and benzodiazepines

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Abnormal liver function tests with ALT >500 and/or concerning features:

  • Evidence of liver decompensation i.e. jaundice and/or ascites and/or encephalopathy

Abnormal liver function tests +/- Low platelets and/or splenomegaly without concerning features:

NB Category 2 cases can be referred to local / regional general physician if gastroenterologist access is not locally available 

No category 3 criteria 

 

Autoimmune liver disease (Autoimmune Hepatitis, Primary Bilary Cirrhosis, Primary Sclerosing Cholangitis)

Essential information (Referral will be declined without this)

  • General referral information
  • Alcohol history
  • ELFT, FBC, INR results
  • HBV, HCV serology results
  • ANA, AMA, SMA, LKM1 results
  • Upper abdominal USS report

Additional referral information (useful for processing the referral)

  • Medication history including non-prescription medications, herbs, supplements
  • For PSC: previous history of IBD, colonoscopy and surveillance
  • Record of previous liver function tests
  • Iron studies
  • IgA, IgG, IgM results
  • Height, weight and BMI

Other useful information for management (not an exhaustive list)

  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Consider cessation of alcohol, hepatotoxic medication, herbal preparations, supplements, NSAIDS and benzodiazepines

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Autoimmune liver disease with abnormal liver function tests and/or concerning features

  • ALT >500
  • Evidence of liver decompensation i.e. jaundice and/or ascites and/or encephalopathy

Diagnosed autoimmune liver disease without concerning features

No category 3 criteria 

 

Elevated iron studies

Essential information (Referral will be declined without this)

  • General referral information
  • Alcohol history
  • ELFT FBC HBV HCV serology Fasting glucose and lipid results
  • Iron studies
  • HFE gene studies
  • Upper abdominal USS reports

Additional referral information (useful for processing the referral)

  • Family history of liver disease or blood disorders
  • Medication history including non-prescription medications, herbs, supplements
  • Previous liver function tests
  • CRP
  • Height, weight and BMI

Other useful information for management (not an exhaustive list)

Medical management

  • Consider elevated ferritin in presence of NAFLD or ALD
  • Consider venesection if serum ferritin >1000ug/L or C282Y homozygous haemochromatosis
  • Monitor iron studies annually if serum ferritin normal
  • Screen adult family members if genetically confirmed in index case
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • There is no need to follow a low iron diet, however people may choose to reduce red meat intake (e.g. to 90-120 g/day)
  • Consider cessation of alcohol, hepatotoxic medication, herbal preparations, supplements, NSAIDs and benzodiazepines

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Ferritin level >1000ug/L +/- elevated transferrin saturation and/or presence of concerning features

  • Evidence of liver decompensation i.e. jaundice and/or ascites and/or encephalopathy

Ferritin level > 500ug/L  and <1000ug/L without presence of concerning features

Normal ferritin with positive HFE gene study

 

Hepatic steatosis/ Non-alcoholic fatty liver disease (NAFLD)

Essential information (Referral will be declined without this)

  • General referral information
  • Height, weight and BMI
  • ELFT FBC HBV HCV serology Fasting glucose and lipid results
  • Upper abdominal USS reports

Additional referral information (useful for processing the referral)

  • Family history of liver disease or diabetes
  • Alcohol and illicit drug history
  • Medication history including non-prescription medications, herbs, supplements
  • Record of previous liver function tests
  • Iron studies/INR
  • Lipid profile

Other useful information for management (not an exhaustive list)

  • Manage metabolic factors
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Address misuse of other substance (illicit and prescription drugs)
  • Education: NASH-cirrhosis and HCC screening

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Hepatic steatosis/ NAFLD/NASH with concerning features:

  • Evidence of liver decompensation i.e. jaundice and/or ascites and/or encephalopathy

Hepatic steatosis / NAFLD without concerning features

NB Category 2 cases can be referred to local / regional general physican if gastroenterologist access is not locally available

No category 3 criteria

 

Hepatitis B Virus

Essential information (Referral will be declined without this)

  • General referral information
  • ELFT FBC Alpha fetoprotein (AFP) results
  • HBV HCV serology results
  • HBV DNA quantitative
  • Upper abdominal USS reports

Additional referral information (useful for processing the referral)

  • Medication history including non-prescription medications, herbs, supplements
  • Record of previous liver function tests, imaging and/or liver biopsy results
  • HIV HDV serology

Other useful information for management (not an exhaustive list)

  • HBV DNA quantitative (patient is eligible for one test per year under Medicare)

Medical management

  • Screening and vaccination for Hepatitis A for patients
  • Screening and vaccination for Hepatitis B of sexual contacts and immediate family members
  • Natural history of disease, transmission risks and precautions,
    • lifelong monitoring of disease if advanced fibrosis/cirrhosis, disclosure, treatment options
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Consider cessation of alcohol, hepatotoxic medication, herbal preparations, supplements, NSAIDs and benzodiazepines

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Patients who are HBsAg positive with concerning features or ALT >100

  • Evidence of liver decompensation i.e. jaundice and/or  ascites and/or encephalopathy

Pregnant women who are HBsAg positive and have HBV DNA >106IU/ml or abnormal ALT

 

Patients who are HBsAg positive without presence of concerning features

No category 3 criteria

 

Hepatitis C virus

Essential information (Referral will be declined without this)

  • General referral information
  • Height, weight and BMI
  • ELFT FBC HBV HIV Fasting glucose  Lipids results
  • HCV serology
  • HCV RNA qualitative/quantitative and genotype
  • Upper abdominal USS reports

Additional referral information (useful for processing the referral)

  • Alcohol and illicit drug history
  • Medication history including non-prescription medications, herbs, supplements
  • Record of previous liver function tests, imaging and/or liver biopsy results

Other useful information for management (not an exhaustive list)

  • Consider alternative referral pathways (local availability) including treatment options in primary care
  • HCV RNA (patient is eligible for one test per year under Medicare)

Medical management

  • Screening and vaccination for Hepatitis A for patients
  • Screening and vaccination for Hepatitis B of sexual contacts and immediate family members
  • Natural history of disease, transmission risks and precautions
  • Lifelong monitoring of disease for hepatocellular cancer screening with USS and AFP if advanced fibrosis/cirrhosis disclosure and treatment options
  • Address misuse of other substance (illicit and prescription drugs)
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Consider cessation of alcohol, hepatotoxic medication, herbal preparations, supplements, NSAIDs and benzodiazepines

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Acute and/or chronic Hepatitis C with concerning features or ALT >500

  • Evidence of liver decompensation i.e. jaundice and/or ascites and/or encephalopathy

Acute and/or chronic Hepatitis C without concerning features

No category 3 criteria

 

Liver cirrhosis

Essential information (Referral will be declined without this)

  • General referral information
  • Family history of liver cancer or other liver disease/s
  • Alcohol and medication history
  • Height, weight and BMI
  • ELFT FBC INR results
  • Alpha fetoprotein (AFP) results
  • HBV HCV iron studies results
  • Upper abdominal USS reports

Additional referral information (useful for processing the referral)

  • Previous endoscopic procedures (date and report)
  • Relevant imaging reports
  • Record of previous liver function tests, imaging and/or liver biopsy results

Other useful information for management (not an exhaustive list)

Medical management

  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Screening and vaccination for Hepatitis A
  • Screening and vaccination for Hepatitis B
  • Lifelong monitoring of disease for hepatocellular cancer screening with USS and AFP if advanced fibrosis/cirrhosis disclosure and treatment options
  • Address misuse of other substance (illicit and prescription drugs)
  • Consider cessation of hepatotoxic medication, herbal preparations, supplements, NSAIDs and benzodiazepines

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Suspected or confirmed severe fibrosis or cirrhosis with concerning features:

  • Evidence of liver decompensation i.e. jaundice and/or ascites and/or encephalopathy

Suspected fibrosis or cirrhosis without concerning features

No category 3 criteria

 

Space occupying liver lesion

Essential information (Referral will be declined without this)

  • General referral information
  • Height, weight and BMI
  • History of liver disease and/or previous cancer/s
  • ELFTs FBC Alpha fetoprotein (AFP) results
  • HBV HCV serology results
  • Relevant imaging reports

Additional referral information (useful for processing the referral)

  • Family history of HCC
  • Past history of cancer e.g. colorectal cancer, gastric cancer
  • History of liver disease
  • Alcohol history
  • Medication history including non-prescription medications, herbs, supplements
  • INR results

Other useful information for management (not an exhaustive list)

  • No other useful information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Space occupying liver lesion on imaging

No category 2 criteria

No category 3 criteria

 

 

Endoscopy

Conditions in scope

Colonoscopy

Essential information (Referral will be declined without this)

  • General referral information
  • Family or personal history of colorectal cancer and any genetic diagnosis
  • Symptom profile
  • Previous endoscopic procedures (date, report and histology)
  • Rectal examination (not required for surveillance referrals and patients with symptoms)
  • ELFT, FBC, iron studies results

Additional referral information (useful for processing the referral)

  • Recent relevant imaging (USS, CT, MRI)
  • iFOBT and Iron studies
  • Faecal calprotectin

Other useful information for management (not an exhaustive list)

  • NB: If a patient who has been fully investigated 2 years prior to referral.  Then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures.

    NB: Faecal calprotectin is a useful test in distinguishing patients with inflammatory bowel disease and irritable bowel syndrome but has no role in detecting colorectal cancer. There is currently no Medicare Benefits Scheme (MBS) rebate for calprotectin.

    Clinical resources

     Patient resources

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Mass palpable on abdominal or rectal examination

  • Positive faecal occult blood test (iFOBT) asymptomatic
  • Severe abdominal pain with presence of concerning features or significant impact on activities of daily living
  • Anaemia or iron deficiency with no obvious cause and/or persisting despite correction of potential causative factors and /or presence of concerning features
  • Altered bowel habits with progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management and with presence of concerning features
  • Rectal bleeding with presence of concerning features
  • Unexplained weight loss and presence of concerning features
  • Abnormal radiology

 

Presence of following concerning features

  • Dark blood coating or mixed with stool
  • Bloody or nocturnal diarrhoea
  • Weight loss, ≥5% of body weight in previous 6 months
  • Abdominal / rectal mass on clinical examination or abnormal imaging
  • Persistent abdominal pain
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • Patient and family history of bowel cancer (1st degree relative <55 years old)
  • iFOBT or calprotectin +ve

NB: For patients with symptoms suggestive of colorectal cancer, the total time from first healthcare presentation† to diagnostic colonoscopy should be no more than 120 days. Diagnostic intervals greater than 120 days are associated with poorer clinical outcomes.

†First healthcare presentation is defined as the date of presentation in general practice with symptoms suggestive of colorectal cancer or positive iFOBT for screening. (Cancer Council Australia, 2017)

 

  • Anaemia or iron deficiency with no obvious cause and/or persisting despite correction of potential causative factors and in the absence of concerning features
  • Altered bowel habits with progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management and in the absence of concerning features
  • Rectal bleeding in the absence of concerning features
  • Unexplained weight loss in the absence of concerning features

 

Absence of the following concerning features

  • Dark blood coating or mixed with stool
  • Bloody or nocturnal diarrhoea
  • Weight loss, ≥5% of body weight in previous 6 months
  • Abdominal / rectal mass on clinical examination or abnormal imaging
  • Persistent abdominal pain
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • Patient and family history of bowel cancer (1st degree relative <55 years old)
  • iFOBT or calprotectin +ve

 

  • Family history of colorectal cancer with either:
    • One first degree relative diagnosed with CRC <55yrs old
    • Two first degree relatives diagnosed with CRC at any age
    • One first degree plus at least two second degree relatives with CRC at any age

 

NB: these relatives with CRC can be taken from both sides of the family i.e. they do not have to be all on the same side.

 

 

Upper GI Endoscopy

 

Essential information (Referral will be declined without this)

  • General referral information
  • Family or personal history of colorectal cancer and any genetic diagnosis
  • Symptom profile
  • Previous endoscopic procedures (date, report and histology)
  • Rectal examination (not required for surveillance referrals and patients with symptoms)
  • ELFT, FBC, iron studies results

Additional referral information (useful for processing the referral)

  • Recent relevant imaging (USS, CT, MRI)
  • iFOBT and Iron studies
  • Faecal calprotectin

Other useful information for management (not an exhaustive list)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

 

 

Category 1 - Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

 

  • For optimal care, patients should be seen within 1 week:
    • suspected GI cancer on clinical examination or abnormal imaging
    • dysphagia with poor oral intake
  • Significant dysphagia
  • Dyspepsia/heartburn/reflux with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) with the presence of concerning features
  • Severe abdominal pain with presence of concerning features or significant impact on activities of daily living
  • Anaemia or iron deficiency with no obvious cause and/or persisting despite correction of potential causative factors and /or presence of concerning features

 

Presence of concerning features

  • Gastrointestinal bleeding
  • Weight loss, ≥5% of body weight in previous 6 months
  • Difficulty swallowing
  • Persistent vomiting
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • Persistent abdominal pain
  • Abdominal mass on clinical examination or abnormal imaging
  • Patient and family history of Barrett’s, oesophageal or gastric or bowel cancer
    iFOBT or calprotectin +ve

 

 

 

  • Dyspepsia/heartburn/reflux with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) in the absence of concerning features

Absence of concerning features

  • Gastrointestinal bleeding
  • Weight loss, ≥5% of body weight in previous 6 months
  • Difficulty swallowing
  • Persistent vomiting
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women

 

  • No category Three

 

Our Specialists

Dr Marianne Mortimore  Director of Gastroenterology, Mater Hospital Brisbane
Dr Jake Begun  
 Dr Linus Chang  
Dr Paul Clark  
Dr Mazhar Haque   
Dr Peter Hendy  
Dr Ji Lee  
Dr Kevin Nanda   
Dr Syvia Vigh  
Dr Nicole Walker  
Dr Johannes Wittmann  
Dr Aidan Woodward   

 

Bulk Billed Clinics

Mater Health offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed clinic, please provide a named referral to one of the specialists listed above.

Contact Us

If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200 

Current Waiting Time for Appointments

We provide up to date data on how long patients are waiting for their first appointment by specialty here.

Referral Guideline Development

These Mater Referral Guidelines align with standardised best practice tools for referral to publicly funded specialist outpatient services developed in Queensland through the Clinical Prioritisation Criteria project.

 

Content last reviewed: 01 May 2019

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