Physician's Assistant

Issues review Thu 27 November 2025 19:54

Last Modified: 130 days ago

MRN:

Content:

Issues:
1. Abnormal liver function tests
- ALP 185 (elevated)
- ALT 42
- AST 51
- Bilirubin 64 (elevated)
- CRP 33 (elevated)

2. Complex past medical history requiring medication review
- Multiple cardiovascular medications
- History of alcohol withdrawal (2016)
- Previous intentional drug overdose (2020)

Background:
66-year-old gentleman with significant past medical history including carotid artery stenosis with TIA in 2021, treated with carotid endarterectomy in August 2021. Initially started on clopidogrel, subsequently changed to rivaroxaban. History of alcohol withdrawal in 2016 and intentional drug overdose in 2020. Other significant medical history includes atrial fibrillation (2014), oesophagitis (2009), and right inguinal hernia repair (2010).

Current medications:
- Venlafaxine 37.5mg MR OD
- Rivaroxaban 20mg OD
- Atorvastatin 80mg OD
- Ramipril 2.5mg OD
- Tamsulosin 400mcg MR OD
- Vitamin B Co-Strong BD
- Bisoprolol 5mg OM
- Mirtazapine 45mg ON
- Omeprazole 20mg OD

Investigations:
Liver function tests: ALP 185, ALT 42, AST 51, Bilirubin 64
Other bloods: GGT 209, Folate normal, Vitamin B12 132, Creatinine 97 (baseline), CRP 33, TSH normal, Transferrin saturation normal
Autoimmune liver profile: Awaited
Full blood count: Normal

Impression:
Abnormal liver function tests with elevated ALP and bilirubin, likely cholestatic pattern. Differential diagnosis includes drug-induced liver injury, biliary obstruction, or chronic liver disease. History of alcohol withdrawal may be relevant.

Plan:
1. Review autoimmune liver profile results when available
2. Consider hepatic ultrasound to assess biliary tree
3. Review current medications for hepatotoxic potential
4. Monitor liver function tests in 2-4 weeks
5. Consider hepatology referral if no improvement or further deterioration

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Summary:

Investigations:

Issues review Thu 27 November 2025 19:54

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