When to consider emergency admission or urgent referral

Patients  who should be admitted to hospital as an emergency include those who are systemically unwell with red-flag symptoms such as:

  • Jaundice
  • ALT more than 500
  • Significant coagulopathy


Patients should be referred for an urgent outpatient appointment if they are systemically well, but have red flag symptoms. When making an urgent referral, it is important that a liver aetiological screen is also organised to check for blood borne and hepatic viruses.

Some patient will have abnormal liver blood tests as a result of an intercurrent illness such as a viral or bacterial infection, or after the commencement of a new medication. If these patients are not systemically unwell and have no red flag symptoms, they should have a repeat liver blood test to check the abnormal liver blood test resolves without the need for intervention.

Some patients will have abnormal liver blood tests from a non-liver cause, including:

  • Elevated bilirubin due to Gilbert syndrome
  • Isolated elevated ALP can be due to vitamin D deficiency
  • Underlying malignancy
  • Raised ALT can be due to muscle injury from myositis or rhabdomyolysis
Mark as Understood

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