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1/16

5/7/54

Noonreport

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2/16

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3/16

Presentillness

6.

clinic

2-3

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Presentillness

1.

paracetamol 44-5.admitX3.

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5/16

Pasthistory

2

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6/16

Familyhistory

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7/16

PhysicalexaminaBon

GA:Anelderlymale,fullyconscious

V/ST:37CPR:68bpmRR:18/minP:91/52mmHg

HEENT:mildpale,markjaundice,paroBdglnotenlargementKFringneg

SCLN,CLNimpalpableHeart:normalS1S2,nomurmurChest&Lung:spidernevi+ve,nogynecomasBa,trachealinmidline,noadvenBous

sound

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PhysicalexaminaBon

Abdomen:nosuperficialveindilate,so[,nottender,nomass

Liver1FbelowRCM,liverspan10cms&spleendullnessposiBve

ExtremiBes:nopalmarerythema,noedema,punctatedwoundatrtlateralaspectof

leg noflappingtremor,noechymosis

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Problemlist

RecurrentJaundice

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10/16

DDx

Viral hepatitis (HBV) Drug & toxin

Autoimmune hepatitis other

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11/16

InvesBgaBon

30/6/54Chol92,Totalprotein7.1,Alb.3.2,Glb3.9,T24.9,D20.2,ALT796,AST

1269Alk.P127

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12/16

InvesBgaBon

HsAgnegAnBHcneg AnBHSnegAnBHCVneg

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13/16

InvesBgaBon

AnBsmoothm.Abpending ANApending IgG25801541-2315]

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14/16

InvesBgaBon

CCHb10.8/hct.30.9 WC5,600(N65L18.7M11.5E4.7MCV80aso0.1)Platelet306,000

UN13.6,Cr1 Na137K3.8HCO328.4Cl104 30/6/54PT15.44,PTT32.48,INR1.48 2/7/54PT15.32,PTT32.42,INR1.47 3/7/54PT14.32,PTT32.42,INR1.41 4/7/54PT14.72,PTT32.42,INR1.36

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InvesBgaBon

3/7/54T28.7,D24.6 4/7/54T27.2,D23.2

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Mx

F/ULFT,INR,hepaBcencephalopathy,liversize