Fast-track Jaundice

Scope:

  • patients 16 years old or over

WITH

  • acute clinical jaundice
    • clinically obvious acute jaundice, or
    • Bilirubin level greater than 50 µmol/L

Out of Scope:

  • patients with deranged liver function tests, but without jaundice (follow the Assessment of Abnormal Liver Function Tests CRG). If you are concerned, please bleep the acute Hep pager 81652 for advice or do an urgent referral.
  • patients under 16 years old (discuss with acute paediatric team)

Assessment

Signs and Symptoms:

  • Clinical jaundice
  • Choluria, pale stools
  • Abdominal/epigastric pain
  • Nausea/vomiting

History and Examination:

  • Weight loss
  • Drugs, including herbal remedies
  • Alcohol intake
  • Recreational drug use
  • Abdominal examination assessing presence of mass, organomegaly, or ascites.
  • Lymphadenopathy

Differential Diagnosis:

The potential cause of jaundice is wide and is divided into obstructive and non-obstructive causes.

  • Obstructive causes include gallstones, pancreatic, biliary, and liver tumours.
  • Non-obstructive causes include acute hepatitis, or in patients with background cirrhosis, decompensation of cirrhosis.

These lists are not exhaustive.

Red Flags

If any of these criteria is present, please consider direct acute admission.

  • Signs of dehydration or not able to keep oral intake.
  • Frail and systemically unwell
  • Febrile
  • Presence of encephalopathy (flapping, new or worsening confusion)
  • INR greater than 1.5

If none of the above are present, but you remain concerned about the safety of your patient, then consider seeking advice from the acute admissions team.

Investigations

No results are mandated at the point of referral of patients with acute clinical jaundice.

However, if possible, please request the following blood tests and attach to the referral form:

  • Liver enzymes (including ALT, AST, GGT, ALP, Bilirubin, and split Bilirubin)
  • Renal Function Tests (including Creatinine, Sodium and Potassium levels)
  • Full Blood Count (FBC)
  • Coagulation screen (PT, APTT, INR)

Management

  • Stop/review drugs with potential hepatotoxicity (e.g., statins, antibiotics, etc.)
  • Advise the patient to keep hydrated.

Referral

Referral Criteria

  • patients 16 years old or over

WITH

  • acute clinical jaundice
    • clinically obvious acute jaundice, or
    • Bilirubin level greater than 50 µmol/L

Referral Instructions

Please, answer the question: “Do you suspect cancer?” in the referral form.

Answer

Time frame of appointment

The answer should be “YES” when there is no clear benign cause to explain the acute jaundice and patient is aged 40 years and over.

Please, inform the patient they are in a suspicion of cancer pathway, and they would be seen within 48 hours from referral.

These patients end up in the same tracking pathway as those referred via the 2ww UGI Tract cancer referral Form.

The answer would be “NO” when there is a clear benign cause of jaundice such as alcohol misuse, or in patients who are aged under 40 years.

Please, inform the patient they would be seen within 1 week.

A confirmation email with the date of the appointment will be sent to the Surgery within 24 hours.

When referring, please share this Patient Information Leaflet with the patient.

This Service is currently active only from Monday to Friday, but not during weekends or Bank Holidays.

e-Referral Service Selection
Specialty: Hepatology
Clinic Type:
Fast track Jaundice Clinic
Service:
Hepatology

Referral Form

Fast-Track Jaundice Clinic - Derriford

Supporting Information

Patient Information

MyHealth website - Jaundice

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Publication date: June 2021

Updated: September 2021

Last updated: 15-09-2021

 

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