Instructions
You are a medical student on placement in general practice. Your next patient is Hung Tran, 68, presenting with yellowing of his eyes and skin.
Take a focused history
Perform an abdominal examination
Outline to the examiner:
- Your findings
- Your interpretation of the results
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
Liver function and coagulation tests
| Item | Value | Reference range |
|---|---|---|
| Total bilirubin | 186 umol/L | 3-20 umol/L |
| Conjugated bilirubin | 151 umol/L | 0-5 umol/L |
| Alkaline phosphatase | 642 U/L | 30-110 U/L |
| Gamma-glutamyl transferase | 811 U/L | 10-70 U/L |
| Alanine transaminase | 118 U/L | 5-40 U/L |
| Aspartate transaminase | 96 U/L | 5-40 U/L |
| Albumin | 31 g/L | 35-50 g/L |
| INR | 1.4 | 0.9-1.2 |
Full blood count and inflammatory markers
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 108 g/L | 130-175 g/L |
| White cell count | 9.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| Platelets | 398 x 10^9/L | 150-400 x 10^9/L |
| C-reactive protein | 18 mg/L | <5 mg/L |
Renal function and electrolytes
| Item | Value | Reference range |
|---|---|---|
| Sodium | 137 mmol/L | 135-145 mmol/L |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
| Urea | 7.8 mmol/L | 2.5-8.0 mmol/L |
| Creatinine | 92 umol/L | 60-110 umol/L |
| eGFR | 71 mL/min/1.73 m2 | >90 mL/min/1.73 m2 |
Glycated haemoglobin
| Item | Value | Reference range |
|---|---|---|
| HbA1c | 63 mmol/mol | 20-41 mmol/mol |