Question 1:
We should consider ascending cholangitis in any patient with fever and features of obstructive jaundice till prove otherwise.
The diagnosis of ascending cholangitis is a clinical diagnosis. Classic Charcot triad of abdominal pain, fever, and jaundice seen only in about 40% of patient.
75 year old lady presented to the emergency department after a fall. In ED she was found to be slightly febrile with blood pressure of 95/55. Part of the investigation performed was LFT and it showed the following:
Bilirubin = 101 umol/L (< 16)
Question 1:
• Hb = 76 (between 7 and 9.9) = moderate anaemia.
Normal MCH and MCV so we have normochromic anaemia.
• WBC = 1.5 (N = 0.9) = mild leukopenia with moderate neutropenia.
• Platelets = 31 (between 70 and 20) = moderate thrombocytopenia.
21 year old girl presented with sudden left sided weakness. Her CT head showed intracerebral haemorrhage. Her full blood picture showed the following:
PH = 7.238, that is moderate acidaemia.
pCO2 = 49.1 mmHg. that is suggestive of respiratory acidosis
HCO3 = 20.2 mmol/L, that is suggestive of metabolic acidosis.
The following blood gases results were given to a doctor to sign, explain the findings
PH = 7.238
pCO2 = 49.1 mmHg
pO2 = 47.7 mmHg
Answers:
Ph = 7.51, that is mild alkalaemia.
HCO3 = 47.5 mmol/L. So, we have metabolic alkalosis.
85 year-old-woman with fracture of right neck of femur. Her blood gases showed the following:
PH = 7.51
pCO2 = 59.5 mmHg
pO2 = 70 mmHg
HCO3 = 47.5 mmol/L
Answers:
Ph = 7.25, that is moderate acidaemia.
pCO2 = 58 mmHg, so we have respiratory acidosis.
18 year-old-girl presented to ED with reduced level of consciousness. She is known to by drugs online.
Her venous blood gases showed the following:
PH = 7.25