Instructions
You are a medical student on placement in general practice. Abraham Akol, 52, who is jaundiced, is here for the results of his blood tests and ultrasound. They are below.
Take a focused history
Interpret the results
Explain the results and your management plan to the patient
Liver function tests, coagulation and viral hepatitis serology (taken 6 days ago)
| Item | Value | Reference range |
|---|---|---|
| Bilirubin (total) | 140 micromol/L | <20 micromol/L |
| Bilirubin (conjugated) | 110 micromol/L | <5 micromol/L |
| Alkaline phosphatase (ALP) | 480 units/L | 30-110 units/L |
| Gamma-glutamyl transferase (GGT) | 620 units/L | <60 units/L |
| Alanine aminotransferase (ALT) | 95 units/L | <40 units/L |
| Aspartate aminotransferase (AST) | 70 units/L | <40 units/L |
| Albumin | 38 g/L | 35-50 g/L |
| Total protein | 72 g/L | 60-80 g/L |
| INR | 1.1 | 0.9-1.2 |
| Hepatitis A IgM | Negative | Negative |
| Hepatitis B surface antigen | Negative | Negative |
| Hepatitis B core antibody (total) | Negative | Negative |
| Hepatitis B surface antibody | 180 IU/L | <10 IU/L (unvaccinated) |
| Hepatitis C antibody | Negative | Negative |
Abdominal ultrasound and full blood count
| Item | Value | Reference range |
|---|---|---|
| Liver | Normal size (14 cm) and echotexture; no focal lesion | Normal |
| Bile ducts | Common bile duct 4 mm; no dilatation of the ducts within the liver | CBD <6 mm |
| Gallbladder | No stones; wall 2 mm; no pericholecystic fluid | Normal |
| Pancreas and spleen | Pancreas visualised, normal; spleen 10 cm; no ascites | Normal |
| Haemoglobin | 142 g/L | 130-180 g/L |
| White cell count | 7.8 x10^9/L | 4.0-11.0 x10^9/L |
| Eosinophils | 0.7 x10^9/L | <0.5 x10^9/L |
| Platelets | 260 x10^9/L | 150-400 x10^9/L |
| MCV | 89 fL | 80-100 fL |
| Lipase | 35 units/L | <60 units/L |