Hepatitis C

Red flags

Consider urgent referral for patients with the following:

  • New hepatitis C infection with jaundice
  • Established cirrhosis, with:
    • GI bleeding (haematemesis, melaena) (send urgently to Emergency)
    • Abnormal INR
    • Marked weight loss
    • Ascites
    • Hepatic mass
  • Signs of hepatic decompensation (send urgently to Emergency)
    • Altered conscious level
    • Confusion
    • New ascites
    • New jaundice

Features that may lead to more urgent categorisation

  • Features of chronic liver disease

Hepatitis C can now be treated and cured with antiviral therapy. Most cases of hepatitis C that have positive hepatitis C RNA should be referred for consideration of antiviral therapy. Patients may be referred to Liver Clinics or Infectious Diseases.

Other important information for referring practitioners

Lifestyle changes

  • Encourage healthy nutrition and lifestyle
    • May require dietary referral if established cirrhosis
    • Avoid constipation if has cirrhosis
  • Assist in stopping iv non-prescription drugs
    • Drug counselling service referral
    • Psychologist referral

Medical management

  • Monitor for hepatic decompensation
    • LFTs, INR
  • Provide education regarding disease and red flags to watch for
  • GPs should familiarise themselves with the new anti-viral therapies currently being used to treat Hepatitis C
  • Current hepatitis C treatment regimens are
    • Weekly Pegylated Interferon alpha injections and twice daily oral ribavirin (peg-IFN-RBV)
  • New regimens are
    • Direct acting antiviral agents (DAAs) combinations. These inhibit various enzymes and stop viral replication. These improve cure rates to over 90% and are soon to be made available.
  • Side effects of anti HCV drugs are
    • Peg-interferon alpha
      • Flu-like symptoms, fatigue, insomnia, depression, psychosis, bone marrow suppression
    • Ribavirin
      • Haemolytic anaemia, nausea, rash

Referral requirements

A referral may be rejected without the following information.

  • Presence of any red flags
  • Reason for referral i.e. new infection, known chronic infection for consideration of anti-viral therapy, management of consequences of chronic hepatitis C
  • History of condition (date diagnosed), include last 3 specialist letters if has been seen previously by a specialist
    • Include likely or known mode of infection
  • Drug history including non-prescription drug use
  • Sexual history
  • Treatment up to date (if any)
  • Investigations
    • FBC, E/LFTs, (alpha fetoprotein if chronic hepatitis C)
    • INR
    • Hepatitis C serology
    • Hepatitis C RNA
    • Ultrasound scan of liver

Additional referral information (useful for processing the referral)

  • Hepatitis C viral genotype and viral load
  • Hepatic fibroscan results
  • Ferritin, ANF, serum copper and caeruloplasmin
  • Gastroscopy results (if oesophageal varices present)

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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