Hepatology services

The Hepatology Service and its Liver Clinic at Royal North Shore Hospital provides specialist Hepatology consultations and multi-disciplinary care for patients within the Northern Sydney Local Health District. We manage patients with liver disease arising from hepatitis B, hepatitis C, non-alcoholic fatty liver disease, alcohol-induced and drug-induced liver injury, autoimmune and metabolic disorders.

The Hepatology Service provides comprehensive assessment and management of patients with primary liver cancers (hepatocellular cancer) and associated liver disease in the context of a multi-disciplinary framework with other medical specialties.

We provide treatment for:

• Hepatitis B
• Hepatitis C
• Liver Disease
• Liver Cancer

We care for and treat people with:

• Cirrhosis
• Chronic Hepatitis B and C
• Non-alcoholic fatty Liver Disease
• Alcoholic Liver Disease
• New Liver Lesions

• Images / Scans
• Blood Results
• List of current medications
• Referral
• Medicare card

Basic investigations required for Liver Clinic Consultation:

• LFTs, EUC, FBC, coagulation
• HBV serology: HBsAg, anti-HBc, anti-HBs; if HBsAg positive, test HBeAg, anti-HBe and HBV DNA
• Anti-HCV Ab; if positive, test HCV RNA(quatitative), HCV genotype
• Liver ultrasound

Referrals with insufficient information will be returned to the GP until further information is provided to the clinic.
 

When to Refer:
Hepatology

• Cirrhosis (any cause)
• Chronic Hepatitis B
• HBeAg positive patients with ALT > 19 units/L (females) and > 30 units/L (males) AND HBV DNA >20 000 IU/mL
• HBeAg negative patients with serum ALT > 19 units/L (females) and > 30 units/L (males) elevated for 3 - 6 months AND HBV DNA >2000 units/mL
• Chronic Hepatitis C
• Anti-HCV Ab positive AND HCV RNA positive
• Non-alcoholic fatty liver disease with elevated ALT
• Alcoholic Liver Disease
• New liver lesion
• Other: abnormal LFTs for evaluation (note mandatory referral info below)
• Post-discharge patients

Urgent Referrals

• Decompensated cirrhosis: jaundice, ascites
• Liver cancer (hepatocellular cancer)
• Patients with positive HBV serology (HBsAg or anti0HBc positive) who are planned for chemotherapy/immunosuppression
• Pregnant women with abnormal LFTs or chronic hepatitis B (HBsAg positive)

Diagnostic Services
FibroScan - GP referral for firbroscan diagnostics are accepted for the following indicators:

• Chronic Hepatitis C (pre-treatment)
• Chronic Hepatitis B
• HCV-HIV co-infection
• Non-alcoholic fatty liver disease
• Alcoholic liver disease
• Primary Biliary Cholangitis
• Liver stiffness un-interpretable
• Acute hepatitis )ALT>10xULN)
• Extrahepatic cholestasis
• Right heart failure, hepatic congestion

Exclusion Criteria:

• Pregnancy
• Pacemaker, implantable defibrillator
• Cirrhosis already diagnosed by clinical, biochemical, &/or radiological methods; ascites
• Liver stiffness un-interpretable

• GP referral
• Medical referral

For referrer use only and is not intended for patients to self-diagnose. Any patients who feel they may require a referral must be assessed and referred by their GP if appropriate.

If you are a GP or Specialist wishing to make a referral, please use the below contacts.

Urgent referrals: Contact the RNSH Switchboard (99267111) and ask to page the on-call gastroenterology registrar.
Routine referrals: Send referral letter via email to NSLHD-RNS-HepatologyService@health.nsw.gov.au or fax to (02) 9463 2041

Mandatory Referral Information: Please address referrals to a consultant being referred to in RNSH outpatients. If unsure, please refer to Dr. Cameron Gofton. All referrals must include a brief summary of the patients' condition, reason for referral, relevant medical history and medications. Any relevant pathology and other relevant test results should be included. Please advise if language translation services are required.

• Resources & useful links
• Click here for details on Remote Hepatology Consultation for HBV Treatment.
• Click here for details on Remote Hepatology Consultation for HCV Treatment.

Can transport be organised for people to attend?

Patients should arrange for their own transport for their clinic appointments.

Is there a cost to patients to attend the clinic?

No. Clinic appointments are free of charge for eligible Medicare card holders.

Non - Medicare card holders may be charged for consultation fees and including other related medical expenses.

• Hepatology Services