A 65 year old man presents to your ED complaining of general weakness, backache and headaches. He has recently arrived in the country from England.

He has no significant past medical history and is on no medication.

His blood results:

Hb  81 (>120)

MCV   93  (82-100)

Platelets  53  (140-400)

WCC   22  (4-11)

Bilirubin  139  (<18)

ALP   142  (<50)

GGT  443  (<50)

ALT   114   (<20)

Albumin  22  (37-45)

Total Protein   132  (30 – 50)

INR   1.5

Na  126  (137-145 mmol/l)

K  4.2   (3.3-5 mmol/l)

HCO3   18

Urea  15.7  (2.8-7 mmol/l)

Creat  276  (<130 umol/l)

Calcium  2.15

Questions:

1. Describe the abnormalities

2. What is the likely diagnosis?

3. What key features must you address in your assessment of the patient?