Review Note

Last Update: 09/24/2023 08:37 AM

Current Deck: Clinical Questions (General)

New Card (Unpublished)

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Front

You are reviewing an 88 year old woman who has been brought in to the emergency room from a high level nursing care home as the staff have noticed that her skin and eyes are becoming increasingly yellow. Her blood tests reveal hyperbilirubinaemia and obstructive pattern liver function tests. Her white cell count is normal and she does not have a fever or signs of sepsis. She is found to have a dilated CBD on USS and likely CBD stones. She is on Warfarin for AF, and has had a previous MCA stroke which has left her with a dense hemiplegia and unable to mobilise independently. She has also been taking 25mg Prednisolone daily for a flare of her polymyalgia rheumatica. After discussion with her and her family, she decided that she would not want any operative management, but she would consent to an ERCP.

What is your immediate management of this patient?

What can be done to optimise this patient before the ERCP?

Her INR comes back as 3.7, how will you manage this?

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