steroids – diuretics – bili and discuss

His parents are upset that he needs another test, and concerned that there may be a problem with his liver now.

The ultrasound has shown a clot in the right femoral vein and Dominic is now on daily subcutaneous heparin, which makes him cry.

The result comes back later that day. 

Bilirubin                                              256 micormol/L

The liver team listen to the story, but will not be able to make a useful comment without a proper set of tests. They leave a list of required investigations. The parents wonder why you did not do them at the same time as the first test.

These test results are available the next day.

Hb       112 g/L

Wcc    6.3 x 10⁹/L

Plats    313 x 10⁹/L

Bilirubin                                              276 micormol/L (228 conjugated)

Alkaline phosphatase             365 U/L

Alanine aminotransferase                  112 U/L

TSH                                                    2.1 mU/L

DCT                negative

Urine MSU     negative

He is discussed again with the hepatology service. They accept him for transfer, but because of the MRSAs that have been identified, will not be able to take him for two days until a cubicle is available.

Dominic’s parents ask whether this could have been avoided earlier.

Further investigations show that he has biliary atresia. He undergoes surgery for this, which is successful. Following this his stools become darker again and he makes good progress.