SAQ 1773 – Epigastric pain after cholecystectomy with abnormal LFTs

A 60-year-old man presents with 12 hours of epigastric abdominal pain. He had a cholecystectomy 4 months ago. His liver function tests are shown, and he then becomes more unwell.

State five differential diagnoses with a discriminatory history or examination feature for each.

(Marked out of 5.0)

/ 5

Provide the most likely diagnosis with justification.

(Marked out of 3.0)

Test	Result	Reference range
Albumin	30 g/L	35-50
Total bilirubin	84 umol/L	<20
Conjugated bilirubin	65 umol/L	<4
ALP	271 U/L	30-110
GGT	1160 U/L	<38
ALT	246 U/L	<34
AST	275 U/L	<31
LDH	287 U/L	120-250

/ 3

State four components of management, with justification and end-points where appropriate.

(Marked out of 4.0)

Observation	Value
HR	110/min
BP	70/50 mmHg
RR	26/min
SpO2	98% on room air
Temperature	39.6 degrees C
GCS	14 (M6 V5 E3)

/ 4

Total Score: 0 / 12

Percentage: 0%