History

Question 1

Ethnicity?

Answer 1

sickle cell affects mainly west African and Afro-Caribbean patients.

Thalassaemias and G6PDH deficiency affect Mediterranean, east Asian and African.

Question 2

are they pregnant?

Answer 2

Intrahepatic cholestasis of pregnancy, pre-eclampsia with HELLP syndrome or acute fatty liver of pregnancy.

Question 3

RUQ discomfort, nausea, vomiting, pruritus?

Answer 3

hepatitis

Question 4

Fever or diarrhoea?

Answer 4

May be present if liver is infected.

Question 5

Steatorrhoea, dark urine and pruritus?

Answer 5

obstruction to biliary flow.

Question 6

weight loss, fever, night sweats?

Answer 6

could indicate a malignancy of the liver, bile duct or pancreas.

Question 7

bronzed skin, signs of DM?

Answer 7

haemochromatosis.

Question 8

exposure to outdoor water / sewage?

Answer 8

Risk factor for leptospirosis.

Question 9

PMH drugs that cause intravascular haemolysis?

Answer 9

sulphonamides, aspirin in G6PDH patients

Question 10

PMH drug that causes autoimmune extravascular haemolysis?

Answer 10

methyldopa

Question 11

PMH drugs that cause hepatitis?

Answer 11

paracetamol OD

Question 12

PMH drugs that cause cholestasis?

Answer 12

co-amoxiclav

Question 13

family history?

Answer 13

Gilberts syndrome, haemochromatosis, Wilsons disease, sickle cell disease, thalassaemia, hereditary spherocytosis, G6PDH deficiency

Question 14

social history?

Answer 14

Alcohol consumption? IV drug use? Unprotected sex? Foreign travel? Tattoos?