Hepatitis A

Red flags

Consider urgent referral to Emergency for patients with the following:

  • Severely abnormal LFTs
  • Signs of hepatic decompensation
    • Altered conscious level
    • GI bleeding (haematemesis, melaena)
    • Abnormal INR
    • Ascites/oedema
    • Persistent vomiting with dehydration not responding to standard anti emetic drugs

Most cases of hepatitis A will not require referral to a specialist and can be managed at home with monitoring for liver function and observing for any more serious features of liver disease. Rarely, patients can develop fulminant hepatic failure due to necrosis of the liver. This is a life threatening condition and if suspected (see red flags) patients should be immediately referred via Emergency.

Other important information for referring practitioners

Lifestyle changes

  • Encourage healthy nutrition and rest
  • Advice re infectivity and mode of transmission (faecal-oral)
  • Avoid alcohol
  • Advise regarding safe doses of paracetamol if to be used for fever etc

Medical management

  • Monitor LFT and general condition
  • Provide education regarding disease infectivity and red flags
  • Offer Hepatitis A immunisation/gamma globulin to close contacts

Referral requirements

A referral may be rejected without the following information.

  • Presence of any red flags
  • Reason for referral
  • Likely or known mode of infection
  • Travel history (if relevant)
  • Drug history
  • Sexual history
  • Treatment up to date (if any)
  • Investigations
    • FBC, E/LFTs, please include serial LFTs if available
    • INR, clotting studies
    • Hepatitis A, B and C serology

Additional referral information (useful for processing the referral)

  • Ultrasound scan of liver

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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