What are the indications for urgent referral to secondary care in adults with jaundice?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Indications for urgent referral to secondary care in adults presenting with jaundice include:

  • Adults aged 40 and over presenting with jaundice should be referred urgently using a suspected cancer pathway referral, due to the possibility of pancreatic cancer.
  • Adults who develop decompensated liver disease symptoms such as ascites, encephalopathy, or gastrointestinal haemorrhage require immediate referral to a hepatologist or gastroenterologist with an interest in hepatology.
  • Adults who test positive for hepatitis B surface antigen (HBsAg) should be referred to a hepatologist, gastroenterologist, or infectious disease specialist with an interest in hepatology, including the results of initial tests.

These referrals are critical to ensure timely specialist assessment and management of potentially serious underlying causes of jaundice.

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