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 BOF 144

 

   

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BOF: 144

A 72 year old female presents with a history of feeling feverish and generally unwell of a few weeks duration. She also complained of vague abdominal pain and said she felt she had lost weight. Apart from diet controlled diabetes mellitus and mild hypertension well controlled with a thiazide diuretic there were no serious illness of note in her past history.

On examination she looked unwell , was febrile , pulse 110 beats per minute , BP 130/70 , heart sounds were normal , percussion note was dull at the right base and breath sounds were absent at the right base.

The abdomen was soft but her liver was enlarged three fingerbreadths and was tender. Bowel sounds were normal

Investigations

Hb 9.8 g/dL

WBC 21 x109/L

Platelets 600 x109/L

Urea 5.2 mmol/L

Creatinine 132 Ámol/L

Sodium 136 mmol/L

Potassium 4.8 mmol/L

Bilirubin 54 Ámol/L

Alanine aminotransferase 72 U/L

Alkaline phosphatase 320 U/L

Chest X-ray small right pleural effusion

Abdominal ultrasound showed 2 hypoechoic lesions in the right lobe of the liver

In this patient which one of the following would you arrange next?

a)    Magnetic resonance cholangiopancreatography

b)    Laparoscopy

c)     Pleural aspiration

d)    Ultrasound guided aspiration of the liver lesion

e)    Colonoscopy

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