So next patient is andrew harrison foxtrot 609923 67 year old man past medical history most recent ogd december 2023 minor reflux esophagitis without attention previous admissions with mild alcohol related hepatitis hypertension anxiety and depression previous barrett's esophagus asymptomatic gallstones in the past medical history 8.3 in mark tretinin 87 electrolytes normal crp 4 lfts bilirubin 26 alt 159 alp normal albumin normal hemoglobin 176 with platelets 129 most recent fibroscan march 2025 5.3 kilopascals iqr / med 15% mrcp march 2025 tiny gallstones but no features of acute cholecystitis or observations respiratory rate 16 sat was 98% on air blood pressure 109 over 83 pulse 80 temperature 37 degrees centigrade so I'll provide the note from the a and e doctor a and e doctor's mentioned alcohol induced liver cirrhosis in the plan in his sorry background however that's not the case he doesn't have alcohol induced liver cirrhosis but he alcohol related liver disease without evidence of fibrosis or cirrhosis on fibroscan okay is mr harrison yes yes hi camilla I'm 1 of their pathology doctors nice to see you nice to see you how are you I'm okay thank you good I'm glad how are you feeling a lot better than was 12 hours ago oh that's good what have we done to make you better nothing that we've done I guess well it's time well not drinking thyme and fluids basically yeah fine you're feeling dehydrated yeah really fine yeah fair enough I understand you've been really good with the alcohol and then had a had a slip up recently yeah I've been all year have been good with the help of harper going on a monthly plane I I go there quite often good and they help me bad session fair enough and I drank then your mood got the better of you yeah yeah it's difficult isn't it when that's your escape agaveuming yeah it can be very difficult but it's after that gotta get straight back yeah how long were you drinking for about 9 days 9 days and how much over that time that would be a bottle during the day so it's 0.75 mhmm right and on a bad day then it would probably be and I'll have to go on top of that but I try and really reduce yeah it's very silly keep it down to 0.75 and you were doing that for 9 days and then you stopped at the yes because you felt ill or I knew I was going downhill so I've got a pretty good supportive family around me and as soon as I start missing replaying to their texts or their messages they and they're there and that's what happened again today they took 1 look at me on the phone for help yeah great and here you are I was saying that drinking like I try and when I go out to buy the bottle also buy a couple of bottles of coke mhmm diet coke so that's that's my staple fluid in as well yeah yeah okay fine but no drink drink of from that that just very few very little food yeah that goes out that's the first thing actually that goes out the window yeah right okay and do you feel healing yourself in any way cough or cold urinary symptoms urinary symptoms yeah again I've got a a slight uncomfortable feeling around the bladder again which I had a couple times ago and I don't know why that suddenly started but actually if it was anything like last time just a matter of 2 or 3 days and it would sort itself out did you have antibiotics last time for a urine infection I did have antibiotics yes your markers of infection aren't very high at the moment I'll add on if there are any subtle markers of infection and we'll take a of your urine and see if there's any infection there does that all work yeah great okay and then other than that it sounds like the a and e team have done a wonderful job they put you on a drip of yeah vitamins and some fluids which is exactly what you need to get you feeling better add some diazepam valcholine draw have you not started it before not started yet I mean the stomach has wasted itself in a bottle no matter what I do to the stomach it still comes back to me the pain and the discomfort discomfort and and vomiting vomiting so this time they actually caught it in time think where I got really really stupid and really really unwell there's certainly no evidence of pancreatitis or any damage there from the drinking to cause and irritate the stomach terribly anti acids or anything like that I'm on omeprazole and pectic quickly as well which they've got prescribed for me which I take mhmm I'll increase the dose of your epidyl slightly while you're in hospital I'll give it to you through a drip yeah try and calm down that stomach sure okay you should make you sure don't have a stress injury a urine infection so I'll get your chest up okay thank you and I don't know how much you know about the health of your liver certainly looking at your recent liver the recent liver scans we've done the fibrous scans everything really we know that we know that your liver is being damaged by alcohol because of the findings on the ultrasound but you haven't developed any stiffness in the liver this is the perfect time to carry on what you're doing and stop because your liver will recover and you'll have a normal liver of it with time considering the abuse I've given you that is quite remarkable that it survived yes some people are just predisposed to it and they drink moderately and they end up with nasty liver disease and some people drink excessively but don't seem to have too much trouble you touch wood and you seem to be doing okay but not a reason to carry on obviously no I can't in a welcoming natural that's really helpful and that is literally not to drink ever again so you've got to find your way over that so have you found hava helpful yes it's very helpful you what kind of things do they do there steve I've mostly 2 group sessions and they actually do acupuncture as well on a wednesday afternoon at stunts and I've got a actually worker drops in we've got a key worker yeah key worker drops in when she can to see yeah her so you're like sister so they are trying their very best yeah well great tell me you are as well so yeah that's really good to have a good experience with you yeah because lots of people struggle I we all think that you know if you engage properly there's loads of things available it's really what did you do for a living do you do for a living well I'm retired now but I was in the royal air force for 25 years and aircraft engineer got out when my time was up and then did working on computers for about 10 years amazing fine and it might be within in the 80s and 90s wasn't it yeah that's right when it just started to but be taking honestly what we had worked with then it makes no sense of what we've got now because the speed of change has been so different exponential and now we're stuck with ai and all that amazing stuff I mean in those days where I was working had the old modem set up okay and that was working at 56 kilobytes per second now you get gigabytes free of your line what a difference yeah mega yeah yeah amazing isn't it yeah kiss it to your heart that's okay can put your arms we're just gonna press for me my my here we go if I'm clear then I'm use the dumbbells no so I was thinking can I in terms of tuck your tummy tender it's not it's only good only slightly tender yeah no it's mainly to prod you and cause the pain no so it is actually since I've been here I've bruised my stomach I've bruised my yeah good I've been throwing up yeah right so that really helps it all lifts your legs you weren't coming off alcohol when you started throwing up you're throwing up with nasty stomach inflammation and pain yeah is that right fine okay as soon as I stopped drinking sip water then that that stopped and then the nausea is pretty much almost gone now good sorry and the and it's do you smoke cigarettes at all no do you vape do you smoke around that no no are you allergic to anyone at home with you no by yourself do have any pets no that's the the the urine sector well I think it might be just because the size of her prostate because the prostate is quite large it's coming for all of us unfortunately mhmm and I think it's but did actually give me antibiotics last time just to make sure I didn't have a slight temperature as well today not at only a very slight temperature but they treated for urinary infection yeah why is that yeah we'll see if there's any sign if there's any hint of urinary infection which is pretty smooth okay yep brilliant don't forget to have some well you've already had the tuna minutes sounds very good yeah I'm I'm slowly getting I'm I'm starting to eat good really good wonderful you're ready great we'll see you then a little later okay yeah nice to meet you thank you very much yep I'll see you you very investigations blood gases reveal lactates 5.9 and 5.7 respectively impression alcohol misuse disorder without evidence of alcohol related cirrhosis lactic acidosis secondary to alcohol abuse plan siwa which is ciwa pabronex for 3 days followed by oral thiamine and vitamin b costrong encourage oral intake iv fluids urine mc + s chest x-ray monitor lfts for possibility of developing mild alcohol related hepatitis plan for hepatology or short stay ward alcohol nursery