A 47-year-old woman presents with right-sided upper abdominal pain for the last 24 hours. Her liver function tests are shown below.
After a short period in the ED she has increasing pain and fever to 39.5 degrees C. Her observations are GCS 15, pulse 110/min, BP 85/45 mmHg, RR 24/min, and oxygen saturation 98% on room air. As part of management, you decide to insert a central venous line.
| Test |
Result |
Reference range |
| Total protein |
70 g/L |
60-80 g/L |
| Albumin |
38 g/L |
35-50 g/L |
| Globulin |
32 g/L |
25-45 g/L |
| Bilirubin |
124 micromol/L |
<20 micromol/L |
| Conjugated bilirubin |
84 micromol/L |
<4 micromol/L |
| ALP |
580 U/L |
30-110 U/L |
| Gamma GT |
870 U/L |
<55 U/L |
| ALT |
205 U/L |
<45 U/L |
| AST |
153 U/L |
<35 U/L |
| LD |
336 U/L |
120-250 U/L |
State your likely diagnosis and explain how the blood results support it.
(Marked out of 2.0)
/ 2
List and justify five further investigations.
(Marked out of 5.0)
/ 5
List four key aspects of management, including endpoints where appropriate.
(Marked out of 4.0)
/ 4
List three potential complications of central venous line insertion and the action you will take to prevent each.
(Marked out of 6.0)
/ 6
Total Score: 0 / 17
Percentage: 0%
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