That's come in if you've got time if we could discuss and just get some advice on your of you that's okay thank you it's his hospital number is +1 32132 9535 9535 thank you and andrew mcloughlin tell me so he's a chap with known cirrhotic liver disease and with variceal funding he had a derek with last year he's come in just generally feeling unwell abdominal pain over the last week and coming in his bilirubin's elevated and let me just sorry yeah that's all good up 1 we've got it at 1 2 5 it's just really with regards to since he's presenting now that we have him in he's known to the torbay liver team but he's had multiple dnas yeah fine it's just whilst he's in if there's any kind of inpatient investigations investigations or management plan that you would provide now that he's come in and we've got him here so his bilirubin is 1 2 5 now and his 1 last 1 in january was 23 mhmm and it's is this alcohol or not yeah alcohol really yeah and is he still drinking alcohol 5 so he was previously drinking 5 pints a day lovely then went he totaled 2 weeks ago and stopped good however last weekend when on a weekend away in london went back to drinking 5 pints a day now he said to us that he now is only drinking about 1 pint a day mhmm but from previous clocking he told other people it's you know 2 to 5 he's gone back to he was scoring on the ciwar earlier overnight in the hours but his morning symptoms didn't so 2 to 5 60 mg total over the last 24 hours of yeah probably and this I've got that yeah quite a classic history for an alcohol related hepatitis which is what this man has isn't it yeah where he you there's a abrupt change in the alcohol intake which means that the hepatocytes become very inflamed so he stopped and then started and stopped again and that's caused him to become profoundly jaundiced that's what this is this is our correlated hepatitis and he needs to be in hospital to manage that there's often an underlying infective trigger I can't see that he's had he's had a chest x-ray that's good but we should make sure he's had some blood cultures and some urine cultures if that's okay okay yeah because yeah there's even in the context of a borderline crp these people can still be harboring an infection and then he had a ct scan back in october chronic liver disease double serious support hypertension fine and then he said he had some varices banded when he was in is that right yeah and that was in january okay no sorry I'm looking at the wrong next he's due to be seen again in january when was he sorry that's not very useful think no that's okay same yeah that makes sense that it wasn't a while ago so basically he hasn't basically he's just dnaed twice in our clinic and then yeah we push out so I don't know what's going on with the boys the boys in beaverford but essentially he he needs to have that decompensated cirrhosis bundle doesn't he because that's what he has is decompensated cirrhosis by definition because he's jaundiced so he should have the alcohol care you're already giving him which is great he should have pavronex for 3 days which I'm sure you're already doing is it coagulopathy no but we should check his inr again tomorrow because if his jaundice goes up he can become coagulopathic we should do a septic screen make sure there's no sign of any infection in his urine or in his blood as a cause for this and his kidney's okay yeah his kidneys are good so we don't have to worry about those is is he bleeding doesn't look like it well when he got 1 it was 152 fine yeah and then he should come to allerton shouldn't he yeah so that we can look after him yeah did you work out with your ruffling of paper whether what the plan was from darafed did you ascertain that or no it's okay if not did you with your ruffling of the paper was there some information that you had about what was happening with with darafed or or not with darafed I wasn't able to find in the paper so I'm still don't worry around in the system apologies don't worry it's absolutely fine I can see he was in in november it wasn't he and is there anything here is he homeless or looks like it's his gp so he has recently separate well split up from his partner who currently stay in a hotel in torbay mhmm but it's normally from kingsbridge area mhmm so it's temporary accommodation at the moment yeah fine you poor chap sounds like everything's gone wrong for him doesn't it and yeah I can't see anything about him the liver doctors back in january 25 fine I heard back from the doctors I plan to see them in 4 weeks they advised you probably need socophate in 4 weeks keep on going when they see you fine who knows what happened but he's between here and derriford so we can admit him and look after him we can do a bit of digging to find out what's going on brilliant alright thank you so much appreciate your help thanks talk to later thanks take care bye andrea mclaughlin +1 329535