BMJ  2004;329:500 (28 August), doi:10.1136/bmj.329.7464.500

Clinical review

Interactive case report

Abnormal liver function found after an unplanned consultation: case outcome

¹ South View Lodge, South View, Bromley, Kent BR1 3DR james.heathcote@gp-G84001.nhs.uk

The first 150 words of the full text of this article appear below.

Four weeks ago (31 July, p 273) we presented the case of Mrs Prior, a 40 year old woman with cystitis, itching, and rash. When her biochemical results showed raised liver enzyme concentrations, her general practitioner was advised to refer her for ultrasonography and an autoantibody test (7 August, p 342). The scan suggested the possibility of hepatic infiltration but the autoantibody screen gave negative results.

Her general practitioner faxed an urgent letter (not a cancer referral) to the consultant, detailing the case history. Nine days later, Mrs Prior was seen in the hospital outpatient department. By then, the jaundice was already fading and her liver enzyme concentrations had improved (alkaline phosphatase 588 U/l, -gluatamyl transferase 686 U/l, and aspartate aminotransferase 74 U/l), although her total bilirubin concentration had risen (193 µmol/l).

The specialist registrar made a presumptive diagnosis of symptomatic gall stone disease and requested urgent computed . . . [Full text of this article]

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