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This page contains information on how to refer patients aged 16 years and over to Gastroenterology and Hepatology services at Mater Hospital Brisbane.
Catchment criteria applies for referrals for this service. Patient referrals from outside the Mater SEQ Catchment (which includes Metro South and West Moreton Hospital and Health Services) may not be accepted.
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
How to send a referral
EMERGENCY-HEPATOLOGY
Potentially life threatening symptoms suggestive of
EMERGENCY- ENDOSCOPY
Upper GI endoscopy
*Acute Severe Colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:
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 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.
Essential information (Referral will be declined without this)
Additional referral information (useful for processing the referral)
Other useful information for management (not an exhaustive list)
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
Essential information (Referral will be declined without this) General referral information Patient and family history of gastrointestinal cancer FBC TSH iron studies results Coeliac serology results 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.
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.
Progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management
Progressive or persistent symptoms with concerning features
Progressive or persistent symptoms despite medical management without concerning features
No category 3 criteria
Essential information (Referral will be declined without this) General referral information 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) Australian clinical practice guidelines for the diagnosis and management of Barrett's oesophagus and early oesophageal adenocarcinoma (2015) recommended screening endoscopy schedules:
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 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. Refer to Healthpathways or local guidelines Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
No dysplasia on endoscopic assessment and Seattle protocol biopsy
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:
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):
High-grade dysplasia or adenocarcinoma on biopsy
Referral to a centre that has integrated expertise in endoscopy, imaging, surgery and histopathology
See other useful information for referring practitioners
See other useful information for referring practitioners)
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) Perform FOBT test every 2 years from age 50-74 years through NBCSP Refer to Healthpathways or local guidelines 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 Clinical resources NHMRC: Clinical practice guidelines for surveillance colonoscopy Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
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
Clinical resources
iFOBT positive in patients > 50-74 years old
No category 2 criteria
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.
Essential information (Referral will be declined without this) General referral information ELFT, FBC iron studies results Coeliac serology (TTG) results 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 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.
NB If patients are on a gluten-free diet, advise them to add gluten to their diet for four weeks before diagnostic testing
NB: If a patient 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.
Positive coeliac serology with concerning features
Presence of concerning features
Positive coeliac serology without red flags
Essential information (Referral will be declined without this) General referral information Medical management to date (document treatments offered and efficacy including failed dietary/pharmocology intervention) FBC TSH iron studies results Serum calcium results 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 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.
NB: If a patient 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.
New onset constipation in patients > 50 years old or patients with any of th efollowing concerning features
Refractory symptoms not responding to medical management without concerning features and affecting activities of daily living
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 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.
Diarrhoea > 6 weeks that is affecting activities of daily living and with any of the following concerning features:
Diarrhoea > 6 weeks without concerning features
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 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.
Consider the following:
Any patient with significant impact on daily living, unexplained, persistent, or recent-onset symptoms (treatment-resistant) with any of the following concerning features:
Any patient with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) without concerning features
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 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.
Significant dysphagia
Previously diagnosed or suspected inflammatory bowel disease with any of the following concerning features:
Stable previously diagnosed inflammatory bowel disease without concerning features
Monitoring and/or bowel cancer screening colonoscopy
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 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.
NB: If a patient 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.
Iron deficiency anaemia or iron deficiency with any of the following concerning features
Iron deficiency without any concerning features
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 Guidelines (2017) 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 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.
Refer to Healthpathwyas or local guidelines
NHMRC Clinical Practice Guidelines (2017) recommended screening colonoscopy schedules for polyp surveillance
NB patients with Familial Adenomatous Polyposis (FAP) and Lynch syndrome (HNPCC) need punctual surveillance due to the high-risk nature of these conditions.
Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
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 NB: If a patient 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.
Rectal bleeding with any of the following concerning features:
Rectal bleeding without concerning features
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.
Abnormal liver function tests with ALT >500 and/or concerning features:
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
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.
Autoimmune liver disease with abnormal liver function tests and/or concerning features
Diagnosed autoimmune liver disease without concerning features
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.
Medical management
Ferritin level >1000ug/L +/- elevated transferrin saturation and/or presence of concerning features
Ferritin level > 500ug/L and <1000ug/L without presence of concerning features
Normal ferritin with positive HFE gene study
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.
Hepatic steatosis/ NAFLD/NASH with concerning features:
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
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 Height, weight and BMI 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.
Patients who are HBsAg positive with concerning features or ALT >100
Pregnant women who are HBsAg positive and have HBV DNA >106 IU/ml or abnormal ALT
Patients who are HBsAg positive without presence of concerning features
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.
Acute and/or chronic Hepatitis C with concerning features or ALT >500
Acute and/or chronic Hepatitis C without concerning features
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.
Suspected or confirmed severe fibrosis or cirrhosis with concerning features:
Suspected fibrosis or cirrhosis without concerning features
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.
Essential information (Referral will be declined without this)
Space occupying liver lesion on imaging
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 Guidelines: Colorectal cancer CPC: Bowel cancer screening CPC: Polyp surveillance Patient resources GESA patient information Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
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.
Patient resources
Mass palpable on abdominal or rectal examination
Presence of following concerning features
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)
Absence of the following concerning features
Essential information (Referral will be declined without this) General referral information Family and personal history of colorectal cancer and any genetic diagnosis Symptom profile - 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 Previous endoscopic procedures (date, report and histology) BMI ELFT, FBC, iron studies results Relevant imaging reports Additional referral information (useful for processing the referral) H pylori results (if indicated) Coeliac disease serology results (if indicated) Past history Barrett’s or fundic gland polyps Atopy 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. Surveillance Barrett’s surveillance Oesophageal varices surveillance in patients who have never bled Genetic cancer surveillance i.e lynch syndrome, familial adenomatous polyposis (FAP), hereditary nonpolposis colorectal cancer (HNPCC) Clinical guidelines Clinical practice guidelines for diagnosis and management of Barretts Clinical practice guidelines for diagnosis and management of Diverticular Disease CPC: Barrett's oesophagus surveillance Patient information GESA patient information Information about diverticular disease Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Absence of concerning features
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.
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
We provide up to date data on how long patients are waiting for their first appointment by specialty here.
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: 12 February 2024
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