EDITOR'S QUIZ: GI SNAPSHOT
Acute liver failure in a patient with lung cancer
1 Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
2 Department of Medical Oncology, Royal Perth Hospital, Perth, Western Australia, Australia
3 Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
Correspondence to:
Correspondence to:
Dr K M Jamil
Department of Gastroenterology and Hepatology, Royal Perth Hospital, GPO Box S1400, Perth, WA 6845, Australia; khaleeljamil@hotmail.com
| The first 150 words of the full text of this article appear below. |
A 63-year-old man with locally advanced non-small-cell lung cancer presented with dyspnoea, cough and pleuritic chest pain. Examination revealed fever and dehydration with normal cardiovascular, chest and abdominal examination.
Investigations: Alanine aminotransferase level 2760 IU/l, total bilirubin 25 µmol/l, alkaline phosphatase 188 IU/l, albumin 39 g/l, 
-glutamyl transferase 318 U/l, international normalised ratio 2.0, creatinine 205 µmol/l, white cell count 13.1x109/l. Screening for causes of acute hepatitis was negative, including hepatitis A, B, C serology, paracetamol level and autoimmune profile. Chest radiograph showed right pleural effusion (fig 1
). Electrocardiogram was normal.
Figure 1 Chest radiograph. Note right pleural effusion.
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Liver and renal function progressively deteriorated (alanine transferase 4000 IU/l, total bilirubin 30 µmol/l, international normalised ratio 3.9, creatine 240 µmol/l). By day three of admission, he developed encephalopathy (asterixis), oliguric renal failure and a metabolic acidosis (pH 7.36, lactate 6.0 mmol/l). Doppler ultrasound scan of the liver showed
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EDITOR’S QUIZ: GI SNAPSHOT
Gut 2007 56: 1209.[Extract] [Full Text] [PDF]
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