Gastroenterology Masterclass

Malcolm is a 64 year old solicitor who attends your surgery having been to a private medical company for a health check.

He has been feeling a bit tired recently and this was the reason for having the check. With the enormous list of essentially normal tests, he has been told that his liver function tests are abnormal and that he should see his GP to discuss this. He is a bit worried and wants it sorted out.

Further questioning reveals he is a regular social drinker, enjoying wine, and taking about 28 units of alcohol per week. He has not had any serious illnesses in the past and is on no regular drug treatment. He has never had a blood transfusion or been jaundiced in the past.

He is happily married with 2 grown up children and denies any extra-marital affairs. He trained as a solicitor slightly later in life having spent some time travelling and working in India after leaving school and he lived on a commune.

On examination there is little to find. He has one possible spider naevus on his face, his palms are a little red but he is not jaundiced and his liver is not palpable.

The private medical investigations have shown normal FBC and multiple screening tests. His liver function tests show bilirubin 17, ALT 72, ALP 180 total protein 76, albumen 34, and gamma GT 350.

Further investigations after a more detailed history and counselling show negative blood tests for Hepatitis A and B and HIV. Hepatitis C screening shows a positive test.

Questions

a) What areas of the history should you explore further? What is the significance of the examination findings?

b) What other investigations that you can do in the surgery will help you to assess the current situation and severity?

c) How would you manage him, and advise him and his wife? What lifestyle advice would you give?

d) What treatment is available? How is the need for treatment assessed by a specialist? What are side effects?