When should I consider referring a patient with jaundice for specialist evaluation?

Consider referring a patient with jaundice for specialist evaluation in the following situations:

• All patients with unexplained jaundice should be referred immediately for further assessment and management in secondary care, as jaundice usually indicates a serious underlying condition such as malignancy or liver disease ¹.
• Refer patients aged 40 years and over with jaundice urgently using a suspected cancer pathway referral to exclude pancreatic cancer ¹,⁵.
• Refer patients with a cholestatic or obstructive pattern on liver function tests (raised bilirubin with raised alkaline phosphatase) to a gastroenterologist, upper gastrointestinal surgeon, or liver clinic, depending on the suspected diagnosis ¹.
• Refer patients with a hepatitic pattern on liver function tests (raised bilirubin with raised alanine transaminase) urgently to a liver clinic or gastroenterologist ¹.
• Refer patients suspected of having alcohol-related liver disease to a specialist experienced in managing alcohol-related liver disease, with urgency based on clinical judgement ¹.
• Refer patients suspected of having inherited liver diseases such as haemochromatosis or Wilson's disease to a gastroenterologist, urgency depending on clinical judgement ¹.
• Arrange same-day admission or urgent referral for patients with jaundice who have red flag signs or symptoms, bilirubin >100 micromol/L, abnormal clotting or coagulopathy, abnormal renal function, suspected paracetamol overdose, frailty, or significant comorbidities ¹.
• Refer patients diagnosed with cirrhosis to a hepatologist or gastroenterologist with an interest in hepatology ²,⁴.
• Refer all adults who are hepatitis B surface antigen positive to a hepatologist, gastroenterologist, or infectious disease specialist with an interest in hepatology ³.