A 50-year-old woman with rheumatoid arthritis has been on methotrexate for several years and is now experiencing abnormal liver function tests. Which blood test should be ordered to determine the underlying cause?
Bilirubin: 15 µmol/l
ALP: 187 u/l
ALT: 58 u/l
γGT: 98 u/l
Albumin: 32 g/l
A 55-year-old woman presents to the clinic with abnormal liver function test results discovered by her primary care physician. Despite feeling well and being asymptomatic, she has a history of Graves’ hyperthyroidism that was treated with radioiodine and is currently managed with thyroxine. During the examination, the patient exhibits palmar erythema and several spider naevi, but the rest of the examination is unremarkable. Her lab results show a slightly low platelet count, low albumin levels, and elevated bilirubin, alanine aminotransferase, alkaline phosphatase, and gamma gluteryltransferase levels. Smooth muscle antibody is not detected, but anti-mitochondrial antibody is detected. What treatment options are available for this patient?
A 42-year-old woman presents with fatigue and intense itching that has gradually developed over several months and has become unbearable in recent weeks. She has a history of hypertension and was diagnosed with diabetes at the age of 12, both of which have been well controlled lately. Her current medications include Lantus, NovoRapid, lisinopril, and simvastatin. On examination, there is widespread excoriation and some hyperpigmentation, but no signs of fluid overload. Mild splenomegaly is noted on abdominal examination.
Blood tests reveal a hemoglobin level of 106 g/L (normal range: 115-165), mean corpuscular volume of 83 fL (normal range: 80-96), white cell count of 3.1 ×109/L (normal range: 4-11), platelets of 35 ×109/L (normal range: 150-400), ferritin of 15 µg/L (normal range: 15-300), bilirubin of 24 µmol/L (normal range: 1-22), AST of 29 IU/L (normal range: 1-31), ALT of 43 IU/L (normal range: 5-35), alkaline phosphatase of 298 IU/L (normal range: 45-105), sodium of 132 mmol/L (normal range: 137-144), potassium of 5.1 mmol/L (normal range: 3.5-4.9), urea of 8.1 mmol/L (normal range: 2.5-7.5), creatinine of 87 µmol/L (normal range: 60-110), lactate dehydrogenase of 450 IU/L (normal range: 10-250), thyroid stimulating hormone of 4.8 mU/L (normal range: 0.4-5), and thyroxine of 13 pmol/L (normal range: 10-22).
Which diagnostic test is most likely to be helpful in this case?
A 63-year-old woman presents to the clinic with a chief complaint of fatigue lasting for six months. She denies any weight loss, change in bowel habits, cough, or sputum production. She also denies having fevers or sweats. She has occasional joint pains due to rheumatoid arthritis, which was diagnosed three years ago. She works as an assistant in a bookshop and lives with her husband. She has three healthy children and no significant family history. She is a lifelong non-smoker and drinks alcohol infrequently. On examination, she appears well and has xanthelasma around both eyes. Scratch marks are visible on her arms, which she attributes to an allergy to a new washing powder. Her pulse is 70/min with blood pressure 110/65 mmHg. Heart sounds are normal with no murmurs or added sounds. Her chest is clear, and the abdomen is soft and non-tender. The spleen is palpable 3 centimetres below the left costal margin, while the liver and kidneys are not palpable. Neurological examination is normal. What is the most likely diagnosis?
A 55-year-old woman presents with a three month history of pruritus and lethargy. She has a history of hypothyroidism but denies regular alcohol intake. On examination, there is evidence of excoriations and xanthelasma. Her blood results show elevated levels of ALT, AST, ALP, and GGT, with normal bilirubin and INR. An abdominal ultrasound scan is normal with no signs of liver or biliary duct abnormalities. What is the most probable diagnosis for this patient?
A 45-year-old man with a history of ulcerative colitis presents to the gastroenterology clinic with abnormal liver function tests. He reports experiencing intermittent jaundice and pruritus, as well as recent right upper quadrant pain. The referral letter includes the following blood results:
Hb 150 g/L (130-180)
MCV 82 fL (80-96)
Platelets 350 ×109/L (150-400)
WBC 5.5 ×109/L (4-11)
Neut 3.5 ×109/L (1.5-7)
ESR 10mm/hour (0-15)
CRP 8 mg/L (<10)
Bil 20 µmol/L (1-22)
ALT 70 U/L (5-35)
ALP 345 U/L (45-105)
Alb 36 g/L (37-49)
GGT 200 U/L (<50)
AST 55 U/L (1-31)
What is the likely diagnosis?
A 35-year-old woman is brought to the Emergency Department after a paracetamol overdose. She admits to taking 40 tablets of 500 mg each with the intention of ending her own life. This occurred 4 hours ago and she has been experiencing increasing abdominal pain and vomiting. On examination, she appears distressed and her right upper quadrant is tender. She has no signs of jaundice and her GCS is 15/15.
Which test is the most reliable indicator of the severity of liver damage in this patient?
A 50-year-old Postmenopausal woman presents with fatigue and lack of energy, with no other symptoms reported. Upon blood tests, she is found to be anemic. Her results show a haemoglobin level of 103 g/L (115-165) and a mean corpuscular volume of 76 fL (80-96), with a ferritin level of 5 µg/L (15-300). Anti-tissue transglutaminase IgA and IgG antibodies are negative, and both gastroscopy and CT colonography do not reveal any cause for iron deficiency. She is prescribed oral ferrous sulphate and after three months, her haemoglobin level increases to 115 g/L. Three months later, she returns to inquire about stopping the oral iron due to nausea. According to the British Society of Gastroenterology guidelines on the management of iron deficiency anaemia, what is the appropriate course of action in this case?
A 62-year-old man visits his doctor with concerns about a change in the color of his skin. He has a medical history of hypertension and drinks 12 units of alcohol per week. During the examination, his skin is noted to have a slate-grey appearance.
Based on his blood test results, what complication is this patient at the highest risk of developing, given his likely diagnosis?
A 50-year-old man comes to the outpatient clinic for follow-up. He was diagnosed with ulcerative pancolitis 10 years ago and is currently on Asacol (mesalazine) treatment. A colonoscopy was performed last month, which revealed mild active inflammation throughout the colon and no polyps. He has no significant family history. What is the recommended time interval for his next surveillance colonoscopy?