Jaundice

Septic shock/Reynolds pentad → emergency resuscitation + urgent biliary decompression

Hypoglycaemia, coagulopathy, encephalopathy → fulminant hepatic failure; maternal and fetal emergency

Encephalopathy/cerebral oedema, hypoglycaemia, rising INR/lactate → transplant centre (King's College criteria)

Severe alcoholic hepatitis (Maddrey discriminant function ≥32) → consider corticosteroids; high mortality

Any conjugated neonatal jaundice — refer urgently; the window for Kasai is narrow

Malignant biliary obstruction with cholangitis -> decompression + antibiotics

E. coli sepsis in a jaundiced neonate on milk → consider galactosaemia

Microangiopathic haemolysis with thrombocytopenia (schistocytes) → TTP/HUS/DIC — a haematological emergency (TTP → plasm

Fulminant hepatic failure (acute); cirrhosis/HCC (chronic); pregnancy (vertical transmission)

Jaundice <24h of age; conjugated (pale stool/dark urine); bilirubin above treatment threshold; encephalopathy (kernicter

Cholangiocarcinoma (rising CA19-9/new dominant stricture); recurrent bacterial cholangitis

Acute liver FAILURE (coagulopathy, encephalopathy) — fulminant hepatitis (esp. B, E in pregnancy) → specialist/transplan

Acute liver failure presentation (coagulopathy/encephalopathy) → urgent specialist

B12-deficiency neurology (subacute combined degeneration) → urgent B12 replacement; do NOT give folate first

Hydrops fetalis; severe fetal anaemia; rapidly rising neonatal bilirubin

Decompensation (ascites/SBP, variceal bleed, encephalopathy) → admit/treat

Very high bile acids (stillbirth risk); features of pre-eclampsia/HELLP or acute fatty liver of pregnancy (a different e

Severe/complicated falciparum malaria (cerebral, hypoglycaemia, acidosis, AKI, high parasitaemia) → medical EMERGENCY →

Any unwell neonate → treat as sepsis until excluded (it can deteriorate fast); meningitis (bulging fontanelle, seizures)

Painless obstructive jaundice + weight loss → urgent imaging/2-week-wait (pancreatic cancer)

Late presentation, staggered overdose, hepatic encephalopathy, raised INR/lactate, acidosis (pH <7.3) → liver-unit crite

Progression to cirrhosis/portal hypertension; HCC risk

Acute chest syndrome (hypoxia + new infiltrate) → emergency (oxygen, analgesia, antibiotics, transfusion/exchange)

Active variceal haemorrhage → major haemorrhage protocol; high mortality

Lyme carditis (heart block) or neuroborreliosis → specialist treatment (IV ceftriaxone)

Sepsis, gangrene/perforation, empyema → urgent surgery

Severe pancreatitis (Glasgow ≥3 / persistent organ failure) → HDU/ITU, high mortality

Sepsis; rupture (into pleura/peritoneum/pericardium)

Acute (fulminant) liver failure in a young person → consider Wilson's (may need transplant)