Gastroenterology Masterclass
Pete
 |
Pete, aged 16, is brought by his father to see you with a one week history of anorexia, flu like symptoms, muscle pains and a sore throat.
He has no significant past medical history and denies using significant alcohol or any recreational drugs.
He has not been abroad recently apart from a family summer holiday in Spain 3 months ago.
He has never had a blood transfusion but has a tattoo of a skull on his left arm much to his father’s disgust!
On examination, apart from his Muse T shirt and baggy combat pants, he has signs of jaundice with icteric sclerae but no other signs of chronic liver disease. His urine and stools are normal colour and liver not palpable.
Investigations show Hb 14.4, MCV 92 with normal wbc and platelets. LFTs show Albumin 44, bilirubin is 52 AST, ALT and gamma GT are normal but alkaline phosphatase is 384.
Questions
a) What are the possible diagnoses?
What is the most likely diagnosis? What other information would you want to check?b) How would you investigate these further and what tests would confirm the diagnosis?
c) What is the significance of the raised alkaline phosphatase?
d) How would you manage this Pete?
Next page: Answers
Back to: Masterclass home page
Study guide by: James Blackstock.
Last updated: 01 October 2006