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 µmol/L
Sodium 136 mmol/L
Potassium 4.8 mmol/L
Bilirubin 54 µmol/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
