Abnormal liver function found after an unplanned consultation: case outcome

doi:10.1136/bmj.329.7464.500

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

James Heathcote, general practitioner¹

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 MrsPrior, 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 ultrasonographyand an autoantibody test (7 August, p 342). The scan suggestedthe possibility of hepatic infiltration but the autoantibodyscreen gave negative results.

Her general practitioner faxed an urgent letter (not a cancerreferral) to the consultant, detailing the case history. Ninedays later, Mrs Prior was seen in the hospital outpatient department.By then, the jaundice was already fading and her liver enzymeconcentrations had improved (alkaline phosphatase 588 U/l, ${gamma}$ -gluatamyltransferase 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 symptomaticgall stone disease and requested urgent computed . . . [Full text of this article]

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