Physician's Assistant

Patient Details

Sdec (257 days ago 12:21)

Sdec Wed 23 July 2025 12:21

Last Modified: 257 days ago

MRN:

Content:

Presenting Complaint:
Lethargy, weakness, reduced oral intake for 6 months

Past Medical History
• Hypertension
• Left caudate nucleus stroke (2025)
• Osteoarthritis of knee (2012)

Diagnosis:
Cholestatic liver function tests - mixed picture, awaiting ultrasound abdomen

I had the pleasure of meeting Julie Armstrong in Same Day Emergency Care today.

Mrs Armstrong is a 74-year-old lady who presented with a 6-month history of lethargy, weakness and reduced oral intake. Her husband reports significant deterioration over recent days, with the patient becoming very pale, lethargic and spending most of her time in bed or sitting with eyes closed. She had severe nosebleeds the previous week lasting up to 2 hours at a time. She reports dark yellow urine and dark stools, with no abdominal pain. There have been no fevers, rigors or weight loss. She has reduced appetite but no nausea or vomiting.

Her past medical history includes hypertension, left caudate nucleus stroke in 2025, and osteoarthritis of the knee in 2012. She lives with her husband in a house but they have moved her bed downstairs due to steep stairs. They are planning to move to ground floor accommodation in the coming weeks. She uses a walking frame at home and was previously receiving carers for personal hygiene but this has been discontinued as she has regained independence.

On examination, she appeared lethargic, tired and pale. She was mildly obese with a soft, non-tender abdomen throughout, Murphy's negative. There was a feeling of upper abdominal fullness but no discrete palpable mass. Her chest was clear with heart sounds showing an ejection systolic murmur radiating to the carotids. There was no peripheral oedema. Communication was limited due to her post-stroke condition, with most history obtained from her husband.

Investigations:
GGT: 274
AST: 244
Creatinine: 43 (baseline)
Bilirubin: 17
ALP: 465
ALT: 382
INR: 0.9
Full blood count: Normal
Immunoglobulins: Normal
Ultrasound abdomen: Very limited views of the pancreas. Hepatic steatosis. Murphy's positive. Cystic endometrial hyperplasia (Gynae/PMB clinic referral is advised.)

Plan:
1. Further bloods including IGG4 and CA19-9
2. Cross-sectional imaging
3.

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Patient Details

Sdec Wed 23 July 2025 12:21

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