Hepato-pancreato-biliary (HPB) referral

Eligibility

At least one must be met for the patient to be eligible for referral.

Patients who are being treated for the same condition at another Victorian public hospital

Children under 18 years of age

Symptomatic gallstones

Asymptomatic gallstones > 2 centimetres

Recurrent biliary colic

Acute liver failure

Suspected acute cholecystitis

Suspected acute cholangitis

Suspected obstructive jaundice

Findings on physical examination

Onset, characteristics and duration of symptoms and sentinel findings (e.g. abdominal pain, weight loss)

Relevant medical history, surgical history and comorbidities (e.g. past history of any malignancy)

Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs)

Red flags

Indicate urgent (Category 1) referral or emergency assessment.

Suspected acute cholecystitis

Suspected acute cholangitis

Suspected obstructive jaundice

Suspected pancreatitis

If cholecystitis is suspected (cholecystectomy is usually indicated)

If pancreatitis is suspected (inpatient management is usually indicated)

If jaundice/cholangitis/suspected pancreas cancer

Acute liver failure

Routine referral criteria

Determine Category 2 or 3 urgency.

Initial primary-care work-up complete (history, examination, baseline investigations per Alfred guideline)

Symptoms persist or progress despite primary-care management

Usually managed in primary care

Patients who are being treated for the same condition at another Victorian public hospital
Children under 18 years of age
Asymptomatic gallstones < 2 centimetres
Gallbladder polyp < 5 millimetres (see further guidelines for referral of gallbladder polyps to
Raised liver function tests without evidence of gallstones or gallbladder polyps – refer to Gastroenterology.se call the mitting Officer on 1800 ALFRED (1800 253 733)
Refer to the full Alfred Health PDF guideline for complete inclusion / exclusion criteria, required investigations and triage categories.