Online OSCEs - Station SEVEN - Liver function tests

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A 68 year-old women is admitted to the surgical ward on the request of her family who are concerned about her health of late.

Liver function tests were performed:

Total Bilirubin: 99

AST: 31

ALT: 34

ALP: 196

GGT: 100

Albumin: 41

Question 1: What would be observed on examining this patient? (1 mark)

Question 2: What might the patient complain of? (3 marks)

Question 3: What specific biochemical abnormality does the patient have? (2 marks)
(ie. What is the clinical term commonly used to describe the biochemical abnormality which this patient has?)

Question 4: What test should be requested next? (1 mark)

Question 5: Give 3 causes of this abnormality (3 marks)

Question 6: What tumour marker might one consider measuring? (1 mark)

Answers:

Answer 1:	What would be observed on examining this patient? Discolouration of the skin - jaundice (1 mark)
Answer 2:	What might the patient complain of? Itch (1 mark) Skin discolouration (1 mark) Pale Stools & dark coloured urine (1 mark)
Answer 3:	What specific biochemical abnormality does the patient have? Obstructive Jaundice (2 marks) (ie. 1 mark for "Obstructive", 1 mark for "Jaundice")
Answer 4:	What test should be requested next? Ultrasound of the abdomen (1 mark)
Answer 5:	Give 3 causes of this abnormality. Intrinsic Bile duct stricture Ampullary carcinoma Cholangiocarcinoma Intraluminal Bile duct gallstone Extrinsic Pancreatic Carcinoma Nodes at the porta hepatis (* one mark for any of the above to a maximum of 3)
Answer 6:	What tumour marker might one consider measuring? CA 19-9 (associated with pancreatic carcinoma) (1 mark)