Physician's Assistant

Issues review Tue 17 June 2025 18:03

Last Modified: 293 days ago

MRN:

Content:

Issues:
1. Acute deterioration in liver function tests with jaundice
- Alkaline phosphatase risen from 180 to 1000 over one week
- Bilirubin increased from 8 to 47 over 3 days
- ALT elevated from 15 to 215
- Patient now clinically jaundiced (new onset)
- No abdominal symptoms
- Pattern consistent with cholestasis

2. Scheduled for urgent lower limb bypass surgery tomorrow morning
- Chronic limb ischaemia requiring limb salvage surgery
- Common femoral to popliteal artery bypass planned
- First on theatre list at 09:00-09:30
- 4-hour procedure under general anaesthetic

Background:
Patient with known hypertension and iron deficiency anaemia. Recently received Ferinject infusion yesterday. LFTs were slightly elevated prior to iron infusion. Current infection screen negative with normal white cell count, CRP 30, normal renal function.

Impression:
Likely choledocholithiasis (ductal stone) causing obstructive jaundice in patient requiring urgent limb salvage surgery

Plan:
1. Hepatology review with bedside ultrasound scan tonight
2. Consider CT abdomen if ultrasound inconclusive
3. Anaesthetic team discussion regarding jaundiced patient for GA
4. Proceed with limb bypass surgery as planned - limb salvage priority
5. Post-operative ERCP if ductal stone confirmed
6. HPB surgical referral for consideration of cholecystectomy

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Summary:

Investigations:

Issues review Tue 17 June 2025 18:03

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