It's mister john ottarall d 4 on clearbrook ward alpha169808 it's an abdominal ultrasound mister patel yes hello how are doing very well how are you not too bad at all really good I'm doctor mel I'm 1 of the pathology specialists we're the liver doctors nice to meet you oh yeah how's she how's your leg my leg is alright but I was just over the news about the I know the liver tests have gone off slightly it's a bit funny there's no real reason for it in terms of your medicines have you had any tummy pain no no fine can I have a look at your liver with my ultrasound machine yeah okay alright do you mind if we drop you on the bed yeah great that's bad have you ever had pain in the past while yeah not a lot to my knowledge on hear that drink fine do you drink alcohol not really mean not not I'm not as ever consistently drinking okay I've had a couple of pills a week when I'm older now for a couple of months so I've been at the start so nothing no yeah and about diabetes do you have diabetes no no okay again not to my knowledge yeah no not to my knowledge I'll just turn the machine on I'm gonna pull it fired up this would have died somewhere on the way over a bit of cold jelly somewhere in the back of it to try and warm it up for a moment I can make it next to cast yeah you got a cabg done with a bypass yeah and you've had a small operation on the tummy no is that right no we've got the bypass report back to finding something right there are never any operations on the tummy no I didn't suffer many years for reflux so I do take them with this control I have to do yeah fine and did you didn't need an operation to very good we just wipe it off on our tops she said what do you mean I said well I know things don't look way for me I mean you're like good she said it's we use a different 1 it's sterilized I said no I already got your room alright yeah I wouldn't trust her interesting what's the name of the drug when did last have something to eat well I just had a biscuit a minute ago mhmm so well about 10 minutes ago well then other than that tea time tea time fine so we're looking at the edge of your liver here it's slightly there's probably a bit of fat in the liver which can be from alcohol can be from well it's just from alcohol it's been there a long time yeah can be from all kinds of things it's probably coming for all of us a little bit of fatty liver as we get older certainly the contour of your liver looks regular which is good I'd to get a good view of your gallbladder and of your liver that's okay because that's what we're interested in it's a bit of a it's not very nice it's been locked away in my nice machine I've been I've been trying to find it so I've got this slightly substernal 1 maybe just a little bit of reasonable view of your liver but it doesn't seem hello jeffrey hello you alright yes I'm mercy 1 of the nurse fights nice you're going for theater tomorrow saturday tomorrow aren't you you will do an x-ray it's would you be able to walk down to x-ray walk down yeah yeah it's alright I'll show you do you know where it is level 6 1 floor down okay towards the main entrance and before the shops there is an ed x-ray and tell me about your leg you've had problems with your leg for a while is that what you're saying yeah you go there and say well I'm not sure you remember he'll do it it's another lady seems so I didn't have any very good circulation in my it's open heart off it on the leg tomorrow mhmm now fingers crossed he's got the wanted to have a dilation of the artery feeding it yeah they're gonna do a prosthetic bypass I think it'll be nice isn't it paris so if he'd known that it was right before I was released from hospital he's the 1 that called me back in mhmm and said he would he could have operated on it before I left the first time that would have been nice that would have been nice wouldn't it and was it sore after the operation or yeah it it went worse did it oh yeah instead of getting better instead of healing the actual wound got worse and what did they think you had a wound infection or something like that yeah I've tried all sorts but they weren't really an infection it just just wouldn't heal it just yeah stayed wide on it stayed open right and I'll be quite honest doctors' surgery are not the most helpful not many people tell me their gp's are very good must admit well good ass line why the hell do you think she can do a diagnosis on the telephone I'd say it's gotta be a bit like trying to watch porn on the radio very good but the sound effect look quite it's a bit of a bad situation they've got themselves in isn't it with all this stuff after covid they made themselves so accessible all these electronic consultations and send them a text and all this stuff that you never used to be able to do yeah and then I then they're just inundated with crap yeah you know what I mean we're just oh I've got a sniffly nose and thing must be your nightmare lots of yeah and also sometimes if you don't know what something is it's quite guilty that's what gps do a lot of the time anyway certainly I do it every now and again when I have something outside of my specialty I don't know how they know everything they must use a lot of Google so the views are exceptionally poor of your liver probably because of a combination of eating recently because we usually would starve people for these scans and having a slightly fatty liver that doesn't let ultrasound waves come through very much even though I'm as I'm sure you've noticed pressing quite firmly I can't get the waves to go through the liver well have you taken any paracetamol lately not really since frontal certainly haven't overdosed on any paracetamol as far as you're aware I'll check your levels to make sure but you don't think you have take any recreational drugs just for fun no they can sometimes inflame the liver and we've treated with your medicine a little but just giving you some iv iron which I doubt very much would cause this you got 1 through there this afternoon yeah the iv iron exactly it's very make it back in I will come I wish there's some morphine and help me sleep tonight as well because my leg is getting quite sore that sounds horrid be quick because I'm just fix it tomorrow I'm looking at very echogenic here isn't it looks like it's in the abdominal fat as opposed to being in and around the liver k any feeding tommy yeah just doing the same just giving you some oxygen now is your are your karen chatting comes over a fairway doesn't it over to you just at the tip of the liver just at the surface here yeah yes think it was just a checkup give him a text yeah if your gallbladder is there it's very small and shrunken down after eating I certainly can't see anything clearly in the ducts surrounding the liver it'll be sorted the views are not great I think let's get the radiologist to scan you first thing in the morning and see what they think okay I think your blood tests make it look like you've got a stone but I think your liver's too fatty for me to see through it to see whether you do have a stone or not a foot what sorry I'm wondering whether you have a stone in your bile ducts your blood tests make it look like you've got a stone in your bile ducts a bile a gallstone yeah gets dropped down into the ducts to drain the liver I'm drawing a picture of the white jelly sometimes you can have them but not have pain pain typically often people will have pain but sometimes people don't always have pain if that makes sense yeah so it's a bit sticky unless you really take it off can I take a look that just a bit of paper sorry I'll have you back how about a little bit yeah it's fine thank you sorry you're very serious the end of the sits at the top of your tummy here and there's ducts that drain the liver of bile and you need bile to help you digest fat yeah it's also part of the breakdown of your red blood cells your gallbladder sits off to the side here and then the ducts drain down they go through the head of the pancreas and are joined by a small duct from there and then they go down into the small intestine your blood test making it like you've got a stone lodged in the duct here I can't see that on my scan because the liver which I'm trying to look through to get into the duct is a bit fatty and not really letting the ultrasound waves travel through because the fat globules just burst the ultrasound waves so we can't see through I suspect there's something there I suspect the best thing to do would be to do a ct scan to look for whether there's a stone there because the ultrasound probably won't be very diagnostic even in experienced hands actually if there is a stone there we've got options with what we do to take it out we can ask the surgeons to do an operation to go in cut the bile duct open take out the gallstone and sew the bile duct back up or we could go in with our camera which goes in through your mouth you're quite sleepy we lie you down in your front in our endoscopy unit we go in with our camera here into your small intestine then we use a wire through the camera to go into your bile duct and we put a balloon on the end of the wire and yank the stone out back on blocking a drain that's called an ercp removal of the gallbladder is a cholecystectomy the removal of that but I don't know 100% that you have a stone here but I suspect you do based on your blood test it could be that there's no stone there and you have a viral infection causing it or the medicines that you're on or something like that so you need to do a few tests to work that out but the pattern of your test makes to me makes it look like you have a stoma so I suspect that's what you've got but I'm often wrong so who knows I'll ask for the test to be added on to look for other potential causes I'll ask them to do a scan either a ct scan tonight which I think will be better or an ultrasound scan tomorrow depending on what the radiologist states to see whether there is a stone there if there is then we can talk about what we do to take it out whether we go in terms of an operation or we do this camera test to unblock it you're a bit yellow you're the jaundiced and we know that when the stone is stuck here it can block up the bile flow the bile backs up through the liver into the blood and it maybe turns your blood yellow and it turns your eyes yellow to slightly jaundiced and we know that when people are jaundiced anaesthetists don't really like their being to sleep because the recovery can be prolonged it can be dangerous your blood pressure can drop quickly after anaesthetic we need to have a good look at your liver and a good look at the ducts to see what's causing this and I worry that that might delay your operation tomorrow I'll speak to the surgeon and the anaesthetist about it and we'll try and get as much information as we can to make sure the operation goes ahead they're unlikely to do it with no information so getting a scan tonight will be really helpful to try and get it tomorrow does that make sense yeah and the blood test that I recommend to the doctor of the doctor is that okay yeah so I'll do those things you'll we'll find out whether you'll get a scan tonight or tomorrow morning depending on your space on the list and how we can facilitate it and take it from there okay is that alright yeah any questions anything I've forgotten okay no problem have you been travelling anywhere exotic no you haven't been travelling anywhere exotic no I've been where in the past I've been travelling the past tell me about in the past when you eventually travel to the city oh yeah probably got a diet most of diarrhea and not getting there never got it never it got I think I only once in 40 odd years of driving a truck all over the world yeah virtually I only once had diarrhea and that was coming off the bloody britney ferries fine I get the prawns okay come on here a second fine alright that's good to know and any tattoos nope nothing like that move from great they just come in to say okay fine I'll as they last and when I had the diarrhea old cockney used to work for the same company oh did he said I've got the round things up killed that and he'd come out with a kaolin and morphine mixture in a bowl right I heard that good to know yeah very good I know that too alright great I'll I'll let you know when it when the tests come back and we'll at that well I'll request all those things for you now the blood test I'll see if we can add on that someone might come and take them from you if not yeah and then the scan will depend on your space on your list and whether they've got space at night to scan them hopefully they will okay alright bye bye see you soon adult medical emergency to surgical assessment