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 BOF 95

 

   

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BOF: 95

A 63 year old male who is known to be hepatitis B positive is admitted with a history of abdominal discomfort and distension. Apart from infection with hepatitis B the patient had no significant past illnesses. He was not on any drugs.

On examination he was deeply jaundiced, there were multiple spider naevi on his upper chest, there was palmar erythema and he had a flapping tremor.

Examination of his abdomen revealed hepatomegaly 4 fingerbreadths, there was a hepatic bruit and he had significant ascites.

Investigations

Hb 12.5 g/dL

WBC 7.2 x109/L

Platelets 65

Bilirubin 300 Ámol/L

ALT 400 U/L

ALP 350 U/L

Albumin 32 g/L

In this patient which one of the following investigations would give you a clue to the cause of his deterioration?

a)      Alpha foetoprotein level

b)      Upper GI endoscopy

c)      Anti HBc IgM antibody

d)     Urea and electrolytes

e)      Urine toxicology screen

 

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