Roman wozniak 1471915 45 year old gentleman investigations hemoglobin a 116 watt cells 14 neutrophils 10.8 low red cell counts usern is normal with creatinine 81 which is at patient's baseline sodium potassium normal lfts alp 1 8 2 alt 42 and bilirubin 202 previously checked on the fifth january was a 177 and prior to that on the december 9 was 50 crp 69 urea 5.5 ast 95 blue top sent but no inr tested venous blood gas ph 7.46 sodium a 126 potassium 3.4 mild hypochloremia glucose 13.2 otherwise unremarkable hello she did take it on your nose mhmm that's very cool yeah medications list metformin 1 g twice a day sitagliptin 1 once per day past medical history type 2 diabetes mellitus november 2025 alcohol dependence coded december 2025 note reviewed by gp today giving blood test results from the fifth feeling lost weight over christmas feeling bloated noticed jaundice stopped alcohol a week ago no tremors or confusion but not feeling well with the gp take your gp wherever you want it's a free free room just go wherever you fancy okay my name's rob I'm 1 of the gastroenterology doctors nice to meet you I was reading from your gp that you've been feeling a bit more unwell since christmas time and losing a bit of weight is that right tell me all about it in christmas time after dinner because I'm eating actually different food like I'm usually eating mhmm then actually I go sleep and I wake up in midden night maybe my head is sweaty it's very I'm kind of breathing and when did it all start when it started with the the tummy swelling increased increased and you said you you have changed what you are eating because you feel very full yeah mean I'm already eating something like myself because I'm worried I'll be I'll be swelling and feeling very bad mhmm actually when I stop completely eating I'm feeling better better mhmm but I'm I'm I'm eating you know some yogurts and stuff like this some bananas orange I'm stop eating because I'm diabetic you're diabetic yes mhmm and I'm stop actually eating any tablets because I'm worried maybe there's a problem with stomach or something mhmm okay if it's if it's a problem with stomach it's not good eating some tablets and stuff like that mhmm so you were taking metformin for your diabetes but you stopped taking that yeah so I'm taking now again and now you're starting yeah okay fine alright after after you know maybe this is a bit like about 5 5 days maybe weekly and then over start you know start start eating and you know mhmm and start feeling actually better good because because before because I was still working actually when this happened what do you do for a living work in a farm in a farm and you know I'm still like you know I have enough enough air mhmm I'm walking into the bed and take breaths know because because you know yeah feeling now is now is better feeling difficult anxious cough actually and this is no no pain as well bringing anything up with the cough sorry is anything coming up with the cough not very bad no a dry cough little bit little bit fluid maybe okay fine pit up speed yeah mhmm and how long actually I'm taking like a strepis strep strep yeah for sore throat and then then take me a little bit out like for it okay I understand but most likely it's like a dry mhmm dry cough dry cough and any pain passing water or urinating no how are your bowels are you opening your bowels okay what do mean going for a poop yeah all okay yeah fine good and this has happened actually in the same like I'm saying the night next day I'm feeling like everything gets stuck like completely not working yeah constipated yeah like yeah and how long will you go between going for a poop every day or every other day or every day every day or twice per day good fine alright brilliant yeah and you it's not so much because I'm not eating so much mhmm I don't eat like fruits and stuff like this and everything just go everything goes through yeah of course and you work on the farm do you live with anyone else no no you're by yourself and where do you live on the farm living in caravan but this is no caravan like outside mhmm this is inside mhmm this is actually like a caravan in a barn yeah fine understood but no barn like yeah like barn this is like a this is this is make it to living up there this is like a home okay just maker from like from a caravan I understand I don't know this is like a like a inside is like home mhmm and still is of the kind of 1 for sleep okay fine understood yeah alright I have like a you know you know like a nice floor everything windows and still eastern is cut out mhmm fine and how long have you been working on the farm for in this farm mhmm in this farm no how long 9 years 9 years almost wow 5 fair enough yeah alright before I'm working in cornwall in cornwall yeah mhmm alright and your I don't know how much you know about the results of your blood tests or the we've done since you came into hospital has anyone told you about it tell me that no fine you're so just tell me the last 1 the worst mhmm but you know for sure the the appetite will probably much higher because I'm not taking tablets we haven't tested you for that and yeah so you've had a few blood tests yeah you've had a count of all of your blood which shows that you're slightly anemic you've got slightly low blood counts and you've also got raised markers of an infection with what you tell me it sounds like you might have a chest infection with this cough no possibly oh yeah your marker of infection in the blood is also raised 69 which we would like to we would like to be lower so all fits with a chest infection have you noticed that your eyes have gone slightly yellow yeah I mean mean I'm before no see this but mhmm when I'm before the blood test in 5 mhmm the the on the fifth she's telling me fine looks like yeah and then I'm checking but now now I think it's a little bit better better fine yeah on the numbers unfortunately it looks worse oh it looks worse so we you see that a product building up in the blood called bilirubin and your level is 202 it's been high for a lie a while back in december it was high and in at the november it was high but it's certainly much higher now the pattern on your blood tests I'm a liver specialist these are your liver tests the pattern on your blood tests makes me concerned about alcohol as a cause for what's going on do you drink alcohol no stop completely okay you don't drink any alcohol at the moment fine and then tell me when did you stop drinking alcohol drinking got it before I said this has happened actually I'm drinking mhmm every day I'm drinking every day mhmm and tell me about that yeah I'm drinking in mean because I cannot sleep mhmm sorry mhmm and and you know and I'm drinking after work yeah mhmm how much are you drinking binks mhmm lager no no no beer cider I'm just drinking I'm just drinking navy rum rum mhmm because because any different alcohol mhmm I'm not feeling well after okay fine mhmm this 1 don't know why but this 1 feeling like go through slowly yeah mhmm and go out slowly yeah I'm not feeling like you know when I'm drinking something different it's like bang bang mhmm yeah and actually that is silly but I'm have like a glucose checking blood checking you know your glucose mhmm and when I'm gonna take all tablet even I'm drink drink the rum I'm still have no very bad not no very bad glucose mhmm like and do you mix the rum with anything yeah what do you mix with fanta 0 most yeah fine so rum and fanta and 2 measures of rum or 3 measures of rum or maybe you like like yeah how long 150 gram 150 grams 200 gram maybe mhmm sometimes mhmm of of rum and then fat on top yeah mhmm with each drink but I mean know this should be like 3 drinks okay 3 4 days understood so how often would you buy a bottle of rum for example 2 3 days mhmm yeah fine and this is a 70 centimeter bottle of rum yes it is yeah fine so maybe half a bottle of rum a day is that fair to say yeah a little bit less little bit less but yeah and how long have you been going like that for quite long yeah 10 years more no no more than years more no less less less before I'm drinking less mhmm much less and have you is has alcohol always been a thing for you sorry has alcohol always been part of your life yeah since you were young yeah always drunk maybe more than you should no like you know yeah but but not that yeah more may more more just like weekend maybe no like every day not like every day so when did the drink drink day maybe 1 beer maybe sometimes a bit no every day yeah and when did it start becoming every day actually you know even even when I'm starting working here actually have no no drinking like every day mhmm so that was 9 years ago but but yeah but but after after you know the job actually as well if I'm driving I'm drinking of course yeah mhmm yeah understood yeah fine but for a while now you've been a few years at least yeah yeah fine obviously I a lot of my patients drink alcohol often to excess yeah and a lot of my patients will tell me a lot about alcohol affecting them yeah so there's nothing you can say because when I'm drinking like you know if I'm drinking after work maybe you know I'm not drinking like time I'm going you know tv or something it's just maybe hour and half of forever and next 1 mhmm but I'm checking my but my you know I'm out for checking my number of you know if if something goes wrong yeah actually I'm very quite quick with alcohol yeah fine so you don't really get intoxicated yeah don't really get drugs because I'm from from we have some special something yeah understand yeah fine this is people you know when you wake up in the morning do you feel like you need a drink no no not really for you fine and you stopped drinking completely so you were drinking 5 drinks and then drinking nothing no I'm drinking nothing sorry do you feel like you're withdrawing from alcohol you look slightly trembly to me do you feel slightly anxious like you are coming off alcohol or not like worse or something like alcohol withdrawal sometimes you can get shaky no anxious don't feel like that and when did you sorry go ahead when I'm drinking like you know like yeah more maybe whatever like I'm having day off I'm drinking more mhmm of course and then and then it's like I'm drink some alcohol mhmm then I maybe go to sleep or something like take longer time mhmm like maybe 8 hours between I see and then I'm I'm feeling like you know yes I want I need a drink mhmm I understand yeah but but but when I'm finished I'm just like finish finishing 1 day and I'm say finish when was that 5 days ago 5 days ago mhmm and actually I'm feeling like you know good I'm glad it's just written with with psychology like you know of course because you like to give gift for for your brain it's like coming from work mhmm someday when you're in the habit it's very hard to break yeah but good for you for breaking it yeah it's very difficult yeah but congratulations for speaking the illness and that is the most important thing you can do we see on your tests that liver is very inflamed because of the alcohol so you have alcohol related hepatitis inflammation of the liver because of alcohol and there's an element of the inflammation in the liver that is from a chest infection as well because the liver is unflamed you've developed some fluid in the tummy I think yeah and that can happen yeah sometimes that fluid can also be infected so it's we can talk about how we investigate that your the most important thing you can do as you said as you know is to stop drinking alcohol we know that if you stop drinking 80% of people will be alive in 10 years time but in your position if you continue to drink we know that 70% of people will be dead within 2 years so it's incredibly important to stop I know you've stopped which is great but staying off is incredibly important when you're while you're in the hospital I will ask some nurses to come and talk to you and give you some help about staying off alcon in the long term is that alright yeah thank you so your liver is inflamed and there is an infection as well it's possible that you have long term liver damage what we call liver cirrhosis from the alcohol it's more than possible I think it's likely unfortunately this probably doesn't need to affect you in the long term if you stop drinking you probably have enough liver to live a completely normal life but just not with alcohol you understand yeah but if you keep drinking the liver will continue to be damaged yeah for you the right amount of alcohol is 0 alcohol any small amount will damage your liver because it is very sensitive at the moment and it will be for the rest of your life okay yeah do you mind if I examine you listen to your chest and look at your hands and also I'll take come back with an ultrasound machine and just scan your tummy and your liver yeah is that alright lovely do you want to jump up there okay I'll come back with the machine in 1 moment can I see your tummy sound like that thanks very much it's really distended isn't it sore at all painful neck welcome to have a look if you like it's cold sorry this is your liver the edge of your liver looks nice and smooth which is good let me just switch it over to the pharmacy so quickly we're just looking at the edge of the liver these subtle lumps and bumps on the liver which might be suggestive of the liver problems in the longer term you see some blood vessels in the liver which look fine and some fluid around the liver a small amount of ascites here this dark stuff is all fluid that is collecting in your tummy oh here fluid in the tummy which is causing the sensation of being full and not being able to eat anything here's the dark stuff the fluid and these are your bowels floating in the fluid see them floating around there's plenty of fluid there okay so sometimes when you get fluid in the abdomen it can have infection inside it and that can cause you to be more yellow and feel more unwell I'd suggest I take a small sample of the fluid it's like a blood test but in the tummy just here I'll give you a bit of local anaesthetic for it but it can be a little bit sore when I put the anaesthetic in is that alright yeah fine alright stop okay doesn't it's gonna happen with every monday it's probably built up slowly over weeks but it reaches a? When you notice but you may not notice before does that make sense you can it can build up silently without knowing okay so gonna have a listen to your chest and the right 1 listen to your heart that's normal big breaths for me now and again good so left lower zone possibly a bit of infection in that left lower zone so I'm going ahead to and make sure that that's not going off can I do the test now is that alright so when did you move to the uk you were in poland what do you say yeah so I'm I'm sorry okay was it always fun work and do you have family or friends over here or anything you know like when I'm in both here okay so yeah no not my brother your brother's here that's are you able to pop this hand on the front like this just so I can keep it clean before cleaning up it couldn't sorry this is the anesthetic a bit stingy like a bee sting alright stretchy bee sting feeling sorry painful good all doing well just take that side oh it's okay okay well done I know it's not very nice thought you would be a heart mare hard work on the farm yeah I bet what kind of farming is it dairy farming dairy big animals surprising I'm a single family member wow really move around every day milking wow just for some milk quite a lot of milk I imagine this is the fluid it looks a bit like weed but it is fluid in the tummy I'll send it off and we'll find out if it's infected where it's coming from and things like that okay so we'll get that result this evening over the next hour or so do you need to stay in hospital strike is that alright by the look of your blood test you might be in hospital for a few days maybe into the middle of next week until the tests get better okay alright is there anyone you want me to tell about that don't know I'm really comfortable say again I think maybe knee you know my was in my brother's room good good you allergic to anything yes are you allergic to anything no no good everyone that comes into hospital I need to ask about resuscitation about cpr and things like that if if you were to deteriorate in hospital we should do everything to keep you alive is that alright no questions about that or worries only because I have to do a form and I have to discuss it with you okay good I'll ask you to be moved into a bed so we can give you some treatment instead of being in the chair I'll do my best actually I'll move here yeah I'll stay here or well in the waiting room you'll be but I will try and get you into a space to give you some treatment okay okay any questions anything at the bottom anything like that no okay not your coat is it no no because it doesn't look like it'd be your better coat no worries it's nice to meet you alright yeah thank you let's go and get you some treatment and give it to you alright you ready bye thank you so much so the impression is alcohol related hepatitis with most likely underlying liver cirrhosis secondary to alcohol alcohol dependence 5 days off alcohol so lower risk for withdrawal however risk remains during the next few days likely left lower zone pneumonia concomitantly and as a further cause of decompensation but it's decompensated alcohol related liver disease with ascites but without encephalopathy aki infection or gi bleeding so the plan is acidic tap undertaken at the bedside with in the right lower quadrant on with ultrasound site marking no complications with verbal consent fluids sent for cell counts mcns cytology and chemistry thiamine or papronex I should say not thiamine for 3 days alcohol care team review iv antibiotics to cover for a pneumonia in the context of liver disease tazosin iv fluids allerton ward add inr to blood tests and give vitamin k if deranged chest x-ray msu if sbp for human albumin solution