Transcription - 20260402T 18-46.mp3

It's a sickness bug it's not been helpful I'm a carer so my sister brings in there it's so hard to walk around it's great so I thought this had all to do with that and then I would be feeling crap so last weekend I somebody's got this real pain down my side was your left hand side yeah lower stomach and I thought well this is ridiculous I'm well over the bugs now so it can't be that far we had doctors on monday she did a urine test she requested bloods so I went and had bloods done I spoke to the doctor today and they said come out I don't know have you seen the blood results I've seen them yeah did they tell you about them at all not them at all fine they just worried you were saying come out I'm sorry they're not gonna be back never the liver the the test showed that your liver tests are slightly elevated right they look like you could have a stone in your liver yeah or in the bile duct draining your liver you could have something gallbladder yeah the gallbladder exactly have you been told about stones in the gallbladder before no just my partner said that so he's gonna gloat now oh no he might not be right good there's still time oh it could be that but it would usually cause pain on the right hand side yeah no worse after fatty meals and you've had it for a while but it doesn't sound like that to you you've got left sided lower pain yeah right other thing could be is a viral infection inflaming the liver or something like that right and you've been off a normal illness yeah yeah that's why I kind of give you the history because I yeah course that was my kind of thought that it is just remnants of infection and things like that yeah and obviously with your infections have you been having also antidote after this for them no nothing like that no any new medicines or changes to medicines only I've been taking an immune booster supplement biocare immune I have to giggle it biocare immune I'm not sleeping not on mounjaro I wish honestly everyone everyone is biocare the logistic gland of nutrients and botanicals vitamins a c zinc I think so this yep that's the 1 very good and elderberry beta glucan lysine and shiitake mushrooms you could take it with thyroxine and mhmm because I'm on thyroxine also fine yeah and any other regular medicines citalopram citalopram fine yeah and has that changed lately nope no nothing else is allergic to anything you know not that I know of fine as well as the low thyroid do have any other medical problems I've got turner syndrome mhmm yeah that's it because my bone thing came up as well why would that be if I blood test it said bony oh the bone profile yeah 1 of the liver tests which comes from the liver but it also comes from some other places is tested in the bone profile so the bone profile group will say abnormal but the calcium is normal right the alp which comes from lots of places including your bones just like the iron right but it looks much more like it's coming from your liver because some of the other liver tests are elevated as well does that kinda make sense yes but it comes from millions of places yeah yeah okay and fevers lately over the last few days or weeks well only when I've been 40 mean obviously I had temperatures then but other than that and when did you have your last temperature 2 weeks ago 2 weeks ago yes mhmm that's when I had the sickness mhmm yeah no 3 yeah 2 weeks ago okay alright and did you have I'll have a look and see did you have blood tests during that time when you were born no just these tests yeah no I just stayed at home and and stayed in bed and took paracetamol and drank fluids that was I thought that's what I'll get through it any recent travel no no more exotic oh I wish no tattoos no no no that's fine cleaned everything alcohol drugs not lately no alright not even too poorly yeah fine with all your infections smoking no I don't and any illicit drugs or anything no no no that's fine and who looks at me I've just got a necklace my partner mhmm and my sister that I care for with fine who's got down syndrome but luckily I'm supposed to be having a week off this week oh that's good she's gone to stay with her dad okay I'm great I was supposed to be enjoying myself yeah awesome did you have any big plans well we were gonna do anything last minute just go somewhere but no never mind sorry never mind and at least it's this has happened while she's not at home mhmm and at the moment you have any muscle aches or coughing cold symptoms I'm at coughing and I'm breathless mhmm and I'm kinda getting pins and needles in my fingers and my toes really weird I did a donald trump I couldn't walk in a straight line can't I walk in a straight line the other day had a real sort of dizzy that's strange but that's evolved now yeah it works yeah yeah but it can it's it's when if I'm laying it's not so bad just the minute I tried to do anything yeah of course yeah yeah fair enough and can I have a quick quick look at you yeah alright make it how's your do you check you don't have take anything off that's all fine any operations on the tummy now I had a hysterectomy years ago but well we'll see you a second what we know no it's more pulses pulse is the other hand thank you that that's great I'll quickly listen to you bryan any cardiac problems with my nervous system sometimes they can't move no they can move no luckily not yet that's good no I'm sure you're midbrain yeah yeah can I touch your tummy that alright can I have look thank you nice it's mostly on that left hand side how about bowels okay yeah when did you last give booking this morning fine it was nice normal poo performed fine and it's kind of struggling bully in no it's maybe more frequent mhmm that's it down here painful no no maybe more frequent yeah to to go for a pee yeah and how about your urine of course and that's okay again it might be more frequent ow you touched there yeah why haven't you touched there sorry take a big breath in and out sorry that's alright and how about now big breath in and out that's at all when you're breathing in no no so you need to get murphy sign okay listen that's okay any gynecological symptoms no discharge loud no not that that's fine can I listen to your back yeah okay take look big breaths whenever you're wet out there fine and up thank you okay sorry give me you don't have to be in 13 clinics you can't don't worry no that's it okay nice call you're any swelling in your legs at no I suppose that can cause it check on everyone don't worry that's fine fine there can be lots of things that cause this happening from the liver blood test a stone as we said can cause it I'd usually expect you to be in more pain focused on the right hand side yeah but obviously pain in the abdomen is very poorly localized yeah so it'd be good to get a scan to see what where to put the stone in your bile duct or so an ultrasound scan would be a very good test there's no radiation and it's very sensitive to ducts they're inflamed or enlarged or with stones in them so it's a very good test the trouble is we're not gonna get it now at 07:00 at night no but we could do in working hours tomorrow or something like that it's friday isn't it we usually get tomorrow we should get an ultrasound tomorrow I think it's good friday it is good friday we'll ask them and see whether they're around in terms of your liver tests it's possible that when you're poorly sometimes the liver becomes inflamed when you're poorly for other reasons because your liver is an immune organ it responds to infection anywhere in your body and the liver tests it's can go possible your liver tests were high when you were infected and now they're coming down but we've just sampled them once so it's difficult to see the trend does that make sense yes so maybe it would be good to have a repeat set of liver function tests tomorrow to see what's going on with those okay to make sure that they're getting better and not getting worse okay okay your the other markers in your blood test looking for significant liver problems are normal you're not sure you're looking for anything which is good and something is inflaming your liver it's difficult to say what I suggest we add a panel of viruses which can inflame the liver so cab and ebv okay what's the blood a test to the blood test we may need to repeat them unfortunately because they go to a different laboratory than the 1 that you love blood tests all over country because they're microbiologists so we'll get a new blood tube and send it off to look for viruses in the blood then they can claim the infection get an ultrasound scan which is the and take it from there okay that sound alright yeah yeah yeah I have a phone ultrasound blood today we can do the blood test today but I won't get an adult today that's the problem so what what happens then I don't have to come out and see a and e again no so what I would suggest is given how well you are which is good we can try and get you out of here which will be good we can work out you're gonna have an ultrasound scan tomorrow we can bring you back to where I sleep medical need to have that ultrasound scan find out what the cause of your liver function test is and repeat them yeah all in all in 1 without having to stay overnight okay that's fine that sound okay okay you've got someone that home can with you and things like that yeah and what they'll give me the time with my ultrasound let's work we'll work out whether we can do it okay are we step 1 busy it's good friday it's done 1 step 2 try and get done okay if not it'll be come in have some blood tests and get on an ultrasound scan but hopefully we're going to keep you in this horrible trolley overnight and you don't think I should take any antibiotics because of inflammation or anything there's no certainly no sign in your blood test of a bacterial infection inflaming your liver what we call cholangitis because you're not the worst it usually be viral infections that inflame the liver in this pattern yeah and so you don't have antimicrobial clearance them the breathlessness is interesting that you described certainly listening to your chest might not find anything to explain breathlessness yeah sometimes when the liver's inflamed it can irritate the diaphragm slightly and you can get warm and you can struggle to become a bit more short of breath yeah we could do an x-ray of the chest and see if there's anything there that might make you feel better let's see the other things first to see if we got q and c we'll find a mixer that sound good okay any questions anything else no sounds like a plan sounds like a like we'll do some research and work out what we can do alright mate yeah I mean I see you nice to meet you do you have any if somebody'll just come to you for that yeah perfect okay go home yeah you can go home don't like it okay yeah it was nausea but I didn't think it was vomiting was it I thought it was just nausea and feeling febrile okay that's that was for 3 weeks have a look at those 2 weeks yeah

Medical ST5 Miller Clerking
04/04/2026 20:48

Presenting Complaint:
Left-sided abdominal pain

History of Presenting Complaint:
Presented following recent blood tests requested by GP after an episode of nausea and fever approximately 2 to 3 weeks ago, which settled with paracetamol and fluids at home. Since then, developed left lower abdominal pain, not typical of biliary colic. Also reported breathlessness, cough, pins and needles in fingers and toes, and a brief episode of dizziness with difficulty walking in a straight line, which has now improved.

She is a carer for her sister, who has Down syndrome. She had been taking an immune supplement, Biocare Immune. No recent travel, tattoos, alcohol or drug use. No recent antibiotics or medication changes.

Past Medical History:
• Turner syndrome
• Hypothyroidism
• Hysterectomy

Drug History:
• Levothyroxine
• Citalopram
• Biocare Immune supplement

Allergy History:
• No known drug allergies

Social History:
Lives with her partner. Carer for her sister with Down syndrome. Non-smoker. No illicit drug use. No recent alcohol intake.

On Examination:
Alert and comfortable at rest.
Observations: Not recorded
• Abdomen: Soft, with mild left-sided lower abdominal tenderness. No guarding. Murphy's sign negative. No dysuria. Bowel habit normal this morning. No vaginal discharge.
• Cardiovascular: Heart sounds normal. Peripheral pulses present.
• Respiratory: Chest clear on auscultation.
• Neurological: No focal neurological deficit elicited.

Investigations:
• Blood tests: Mildly deranged liver function tests with elevated ALP and other liver enzymes. Bone profile abnormal due to ALP, with normal calcium. Other markers for significant liver disease normal.

Impression:
Mild transaminitis with raised ALP, likely reactive to recent viral illness. Differential diagnoses: biliary obstruction/choledocholithiasis, gallstones, viral hepatitis.

Management Plan:
1. Arrange repeat liver function tests tomorrow.
2. Arrange viral screen including EBV and CMV.
3. Organise abdominal ultrasound to assess biliary tree and gallbladder.
4. No antibiotics indicated at present as there is no evidence of bacterial cholangitis.
5. Consider chest X-ray if breathlessness persists or needs further assessment.
6. If clinically well and investigations can be arranged, discharge home with follow-up for imaging and blood tests.

Summary

Investigations

Plans

Medical ST5 Miller Clerking
04/04/26 20:49

Presenting Complaint:
Left-sided abdominal pain

History of Presenting Complaint:
Presented with a 2-week history of feeling unwell following a presumed viral gastroenteritis. She reported nausea and feverish episodes at the time, managed at home with paracetamol and fluids. Since then, she has developed left-sided lower abdominal pain, with some urinary frequency. She also described breathlessness, pins and needles in the fingers and toes, and a recent episode of dizziness with difficulty walking in a straight line, which has since improved.

She saw a doctor on Monday and had a urine test and blood tests arranged. Blood results showed mildly abnormal liver function tests, including a raised alkaline phosphatase, with otherwise reassuring markers. There was concern regarding possible biliary pathology, although the pain is not typical for biliary colic as it is left-sided rather than right-sided and not clearly related to fatty meals.

No recent travel, tattoos, alcohol excess, recreational drug use, or antibiotic exposure. No new prescribed medications. She takes an immune booster supplement, Biocare Immune, which she says she can take with thyroxine.

Past Medical History:
• Turner syndrome
• Hypothyroidism
• Previous hysterectomy

Drug History:
• Thyroxine
• Citalopram
• Biocare Immune supplement

Allergy History:
NKDA

Social History:
Lives with her partner. She is a carer for her sister, who has Down syndrome. Her sister is currently staying with her father, so she has a week off. She is a non-smoker. No alcohol or illicit drug use.

On Examination:
General appearance: Comfortable and able to converse.
Observations:: Not recorded.
• Abdomen: Soft. Mild left-sided lower abdominal tenderness. No right upper quadrant tenderness. Murphy's sign negative. No guarding or peritonism.
• Cardiovascular: Normal peripheral pulses. No leg swelling.
• Respiratory: Breathless by history. Chest examination not reported as abnormal.

Investigations:
• Urine dip (Monday): Performed by GP; result not provided.
• Blood tests: Mildly elevated liver function tests, including alkaline phosphatase. Other markers for significant liver disease normal.

Impression:
Abnormal liver function tests with left-sided abdominal pain following recent viral illness.
Differential Diagnoses: Gallstones/choledocholithiasis, viral hepatitis or post-viral transaminitis.

Management Plan:
1. Arrange repeat liver function tests tomorrow.
2. Arrange viral hepatitis screen and EBV testing.
3. Request ultrasound scan of the liver and biliary tree.
4. No antibiotics indicated at present as there is no evidence of bacterial cholangitis.
5. Consider chest X-ray if breathlessness persists or if clinically indicated.
6. Discharge home if clinically well, with outpatient investigation arranged and return instructions discussed.

Summary

Investigations

Plans

Medical ST5 Miller Clerking
04/04/26 20:55

Presenting Complaint:
Abdominal pain

History of Presenting Complaint:
Presented with left lower abdominal pain following a recent viral illness with nausea and feverish symptoms. She initially thought her symptoms were related to a sickness bug, which had been affecting her ability to walk around and function. Last weekend she developed pain on the left side of the lower abdomen, which prompted review by her GP on Monday. Urine testing was performed and bloods were requested. She was contacted today because of abnormal blood results.

Blood tests showed mildly deranged liver function tests and abnormal bone profile, with raised alkaline phosphatase felt to be of hepatic origin as other liver markers were also elevated. There was concern for possible biliary pathology, including gallstones or a stone in the bile duct, although the pain is not typical for this and is not right-sided or clearly post-prandial. Viral hepatitis or another viral illness causing liver inflammation was also discussed as a possibility.

She reported fever during the initial illness, with the last temperature about 2 weeks ago. She has also had cough, breathlessness, pins and needles in her fingers and toes, dizziness, and difficulty walking in a straight line. These symptoms have improved somewhat, but she still feels unwell, particularly on exertion. No recent travel, tattoos, illicit drug use, or antibiotic use. She has been managing at home with paracetamol and fluids. No change in bowel habit other than possibly more frequent motions and more frequent urination. No dysuria. No vaginal discharge. No right-sided pain or pain on deep inspiration.

Past Medical History:
• Turner syndrome
• Hypothyroidism
• Hysterectomy

Drug History:
• Levothyroxine
• Citalopram
• Biocare Immune supplement

Allergy History:
• NKDA

Social History:
Lives with partner and sister, whom she cares for. She is a carer. Her sister has Down syndrome. Smoking: non-smoker. Alcohol and illicit drugs: denies.

On Examination:
Alert and comfortable at rest.
Abdomen: Soft, mildly tender in the left lower quadrant. No right upper quadrant tenderness. No Murphy's sign. No guarding or peritonism.
Cardiovascular: No peripheral oedema.
Respiratory: Breathlessness reported, but chest examination not described as abnormal.

Investigations:
• LFTs: mildly elevated, with raised alkaline phosphatase and other liver markers also elevated
• Bone profile: abnormal secondary to raised alkaline phosphatase; calcium normal
• Urine dip: performed by GP

Impression:
Mild transaminitis with raised alkaline phosphatase, likely hepatic in origin.
Differential Diagnoses: Transient viral hepatitis; biliary obstruction/choledocholithiasis; gallstones.

Management Plan:
1. Repeat liver function tests tomorrow.
2. Arrange viral screen including hepatitis and EBV serology.
3. Arrange abdominal ultrasound scan to assess liver, gallbladder and biliary tree.
4. No antibiotics indicated at present as there is no evidence of bacterial cholangitis.
5. Consider chest X-ray if breathlessness persists or if clinically indicated.
6. Discharge home if well, with outpatient imaging and blood tests arranged, rather than admission overnight.

Summary

Investigations

Plans

Medical ST5 Miller Clerking
04/04/26 21:02

Presenting Complaint:
Left lower abdominal pain

History of Presenting Complaint:
Presented with a recent viral illness, described as a sickness bug, associated with nausea and fever/temperatures around 2 weeks ago. She remained at home, rested in bed, and took paracetamol and fluids. Since then she has felt generally unwell, with reduced sleep and some shortness of breath. Over the last weekend she developed pain down the left side, mainly in the left lower abdomen. She initially wondered if this was related to the recent infection but sought medical review due to persistence.

She saw her GP on Monday, had a urine test and was asked to have blood tests. Results showed mildly abnormal liver function tests. She reports intermittent fever only during the recent viral illness, with no recent travel, tattoos, alcohol excess, or illicit drug use. No new prescribed medications; she has been taking Biocare Immune supplement. She also reports pins and needles in her fingers and toes and a brief episode of dizziness with difficulty walking in a straight line, which has since improved. No cough or coryzal symptoms. Bowels are normal, with a normal stool this morning. Urinary frequency is slightly increased but urine otherwise normal. No vaginal discharge.

Past Medical History:
• Hypothyroidism
• Turner syndrome
• Hysterectomy

Drug History:
• Levothyroxine
• Citalopram
• Biocare Immune supplement

Allergy History:
• No known drug allergies

Social History:
Lives with partner.  
Cares for her sister, who has Down syndrome.  
Smoking: non-smoker.  
Alcohol: denies recent alcohol use.  
Illicit drugs: denies.  
Functional status affected recently by feeling unwell and difficulty walking around.

On Examination:
General appearance: Alert and well enough for discharge.  
Abdomen: Soft, tender in the left lower abdomen. No guarding. No right upper quadrant tenderness. Murphy’s sign negative. No abdominal findings to suggest cholecystitis.  
Cardiovascular: Heart sounds heard, no abnormalities reported. Peripheral pulses present.  
Respiratory: Breathlessness reported, chest examination not reported as abnormal.  
Neurological: Brief dizziness and pins and needles reported, no persistent focal deficit described.

Investigations:
• Liver function tests: Mildly elevated, with raised ALP and other liver enzymes; pattern felt more consistent with hepatobiliary source than bone source
• Bone profile: ALP abnormal, calcium normal
• Urine test (GP): Done prior to referral, result not stated

Impression:
Mild transaminitis / cholestatic liver biochemistry following recent viral illness.  
Differential Diagnoses: Gallstones / choledocholithiasis, viral hepatitis, post-viral hepatitis.

Management Plan:
1. Discharge home as clinically well.
2. Arrange repeat liver function tests tomorrow.
3. Arrange viral hepatitis screen, including hepatitis B and EBV.
4. Arrange abdominal ultrasound scan tomorrow to assess gallbladder and bile ducts.
5. No antibiotics indicated; no evidence of bacterial cholangitis.
6. Consider chest X-ray if breathlessness persists or if clinically indicated.

Summary

Investigations

Plans

Medical ST5 Miller Clerking
04/04/2026 21:07

Presenting Complaint:
Abdominal pain

History of Presenting Complaint:
Presented with left lower abdominal pain following a recent viral-type illness. She had been unwell with nausea and feverish symptoms around 2 weeks ago, after which the abdominal pain developed. She reported associated breathlessness, cough, pins and needles in the fingers and toes, and dizziness with an episode of difficulty walking in a straight line. Symptoms were worse when up and about and less noticeable when lying down. She denied right upper quadrant pain, pain worsened by fatty meals, jaundice, change in bowel habit, dysuria, vaginal discharge, recent travel, tattoos, alcohol excess, smoking or illicit drug use.

She is a carer for her sister, who has Down syndrome, and has been struggling to mobilise because of feeling unwell. She has a partner at home and her sister is currently staying with her father, so she has the week off.

She was seen by a doctor on Monday, when a urine test was done and blood tests were requested. Blood results were reviewed today and showed mildly abnormal liver tests and bone profile, prompting assessment.

Past Medical History:
• Turner syndrome
• Hypothyroidism
• Hysterectomy

Drug History:
• Levothyroxine
• Citalopram
• Biocare Immune supplement

Allergy History:
• No known drug allergies

Social History:
Partner at home. Carer for sister with Down syndrome. Smoking: non-smoker. Alcohol: denies. Recreational drugs: denies.

On Examination:
Alert and not acutely unwell.
Observations: not documented.
• Abdomen: Soft. Mild left-sided lower abdominal tenderness. No right upper quadrant tenderness. No peritonism. Murphy's sign negative.
• Cardiovascular: Normal peripheral pulses. No leg swelling.
• Respiratory: Breathless by history. Chest examination not documented.
• Neurological: No focal deficit elicited on brief assessment.

Investigations:
• Liver function tests: Mildly elevated transaminases and cholestatic enzymes, with raised alkaline phosphatase.
• Bone profile: Abnormal due to alkaline phosphatase, with normal calcium.
• Urine dipstick: Performed by GP.

Impression:
Mild transaminitis with raised alkaline phosphatase following recent viral illness. Differential diagnoses: transient viral hepatitis, biliary obstruction/choledocholithiasis, gallstones.

Management Plan:
1. Repeat liver function tests tomorrow.
2. Arrange viral hepatitis/EBV screen.
3. Arrange urgent abdominal ultrasound to assess the liver and biliary tree.
4. No antibiotics indicated at present as there is no evidence of bacterial cholangitis.
5. Consider chest X-ray if breathlessness persists or if initial investigations do not explain symptoms.
6. Discharge if well, with outpatient follow-up for investigations and results.

Summary

Investigations

Plans

Medical ST5 Miller Clerking
04/04/2026 21:08

Presenting Complaint:
Left-sided abdominal pain

History of Presenting Complaint:
Patient recently had a vomiting and febrile illness approximately 2 to 3 weeks ago, which settled with rest, fluids and paracetamol. Since then, she has remained generally unwell with poor sleep and ongoing breathlessness. Over the last weekend she developed pain in the left lower abdomen/left flank. She was reviewed by a doctor on Monday and had a urine dip and blood tests arranged. Blood results today showed mildly elevated liver function tests and abnormal bone profile with normal calcium. She also reports pins and needles in the fingers and toes, and an episode of dizziness with difficulty walking in a straight line a few days ago, which has improved. No recent travel, tattoos, alcohol misuse or illicit drug use. No recent medication changes apart from starting Biocare Immune supplement. No right upper quadrant pain, no postprandial fatty food-related pain, and no history of known gallstones. No persistent fever over the last few days. No bowel or urinary symptoms of concern, although she may be passing urine more frequently.

Past Medical History:
• Hypothyroidism
• Turner syndrome
• Previous hysterectomy

Drug History:
• Levothyroxine
• Citalopram
• Biocare Immune supplement

Allergy History:
• No known drug allergies

Social History:
Lives with partner and sister for whom she is a carer. Sister has Down syndrome. She is a non-smoker. No illicit drug use. No recent alcohol excess. Functional capacity currently reduced by feeling unwell and breathless.

On Examination:
Alert and clinically stable.
Cardiovascular: Heart sounds normal. Peripheral pulses present.
Respiratory: Chest clear on auscultation.
Abdomen: Soft. Mild tenderness in the left lower abdomen. No right upper quadrant tenderness. No guarding or peritonism. Murphy's sign negative.
Neurological: No focal deficit on brief assessment.
Other: No leg swelling.

Investigations:
• Liver function tests: Mildly elevated.
• Bone profile: Abnormal due to elevated alkaline phosphatase; calcium normal.
• Other liver blood tests: No evidence of significant liver failure or bacterial cholangitis.
• Urine test: Performed by GP prior to attendance.

Impression:
Mild transaminitis with elevated alkaline phosphatase, likely post-infective or hepatobiliary in origin.  
Differential Diagnoses: Gallstones/choledocholithiasis, viral hepatitis, post-viral inflammatory change.

Management Plan:
1. Arrange repeat liver function tests and bloods for viral hepatitis/EBV screen.
2. Request abdominal ultrasound to assess for gallstones or biliary obstruction.
3. No antibiotics indicated at present as there is no evidence of bacterial cholangitis.
4. Consider chest X-ray if breathlessness persists or if initial work-up is unrevealing.
5. Discharge home if clinically well, with outpatient follow-up for ultrasound and repeat bloods.

Summary

Investigations

Plans