Abnormal liver function found after an unplanned consultation: case presentation
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《英国医生杂志》
1 South View Lodge, South View, Bromley, Kent BR1 3DR, james.heathcote@gp-G84001.nhs.uk
Mrs Prior is a 40 year old housewife whose husband frequently attends the surgery because of his diabetes. They are a close couple, and she takes the lead in managing his condition. In the past three years she has consulted her general practitioner just once on her own account—for dyspepsia. During one of her husband's consultations (and quite out of character) she mentions three problems of her own: a seven day history of intermittent "cystitis," for which she had taken over the counter sodium citrate; generalised itching; and a rash that looks to her general practitioner like seborrhoeic dermatitis.
In the limited time available (this is, after all, her husband's consultation) the general practitioner ascertains that her weight is steady and she is otherwise well, before examining her quickly to rule out any obvious skin disease to account for the itching. He finds no hepatomegaly and no jaundice. He then orders a laboratory midstream urine culture, full blood count, electrolytes, plasma glucose, and liver function tests and prescribes a short course of cefalexin for the cystitis and a tube of cream containing hydrocortisone (1%) and miconazole (2%) for the rash.
Questions
What do these results suggest?
If you were her general practitioner, what would you do now and with what urgency?
What would you tell Mrs Prior?
Please respond on bmj.com
Two days later, the urine result confirms an Escherichia coli infection with a high white blood cell count and culture of > 100 000 organisms/ml. It is sensitive to cefalexin. Eight days after the initial consultation, Mrs Prior goes for her blood tests. The results come back to the general practitioner the next day (table). Mrs Prior has not yet made a follow up appointment.
Results of biochemical analysis and full blood count
Competing interests: None declared.
This is the first of a three part case report where we invite readers to take part in considering the diagnosis and management of a case using the rapid response feature on bmj.com. Next week we will report the case progression and in four weeks' time we will report the outcome and summarise the responses
We welcome contributions of interactive case reports. Cases should raise interesting clinical, investigative, diagnostic, and management issues but not be so rare that they appeal to only a minority of readers. Full details of criteria are available at: bmj.com/cgi/content/full/3267/7389/564/DC1(James Heathcote, general )
Mrs Prior is a 40 year old housewife whose husband frequently attends the surgery because of his diabetes. They are a close couple, and she takes the lead in managing his condition. In the past three years she has consulted her general practitioner just once on her own account—for dyspepsia. During one of her husband's consultations (and quite out of character) she mentions three problems of her own: a seven day history of intermittent "cystitis," for which she had taken over the counter sodium citrate; generalised itching; and a rash that looks to her general practitioner like seborrhoeic dermatitis.
In the limited time available (this is, after all, her husband's consultation) the general practitioner ascertains that her weight is steady and she is otherwise well, before examining her quickly to rule out any obvious skin disease to account for the itching. He finds no hepatomegaly and no jaundice. He then orders a laboratory midstream urine culture, full blood count, electrolytes, plasma glucose, and liver function tests and prescribes a short course of cefalexin for the cystitis and a tube of cream containing hydrocortisone (1%) and miconazole (2%) for the rash.
Questions
What do these results suggest?
If you were her general practitioner, what would you do now and with what urgency?
What would you tell Mrs Prior?
Please respond on bmj.com
Two days later, the urine result confirms an Escherichia coli infection with a high white blood cell count and culture of > 100 000 organisms/ml. It is sensitive to cefalexin. Eight days after the initial consultation, Mrs Prior goes for her blood tests. The results come back to the general practitioner the next day (table). Mrs Prior has not yet made a follow up appointment.
Results of biochemical analysis and full blood count
Competing interests: None declared.
This is the first of a three part case report where we invite readers to take part in considering the diagnosis and management of a case using the rapid response feature on bmj.com. Next week we will report the case progression and in four weeks' time we will report the outcome and summarise the responses
We welcome contributions of interactive case reports. Cases should raise interesting clinical, investigative, diagnostic, and management issues but not be so rare that they appeal to only a minority of readers. Full details of criteria are available at: bmj.com/cgi/content/full/3267/7389/564/DC1(James Heathcote, general )