GP surgery

You are the SHO in your morning clinc. The next patient to be seen is Joel Brown, a 54 year old gentleman, known to have had problems with alcohol in the past. He has been seen in the Emergency Department twice in the past two weeks.

On questioning he says that for the past 5 days he hasn't felt right. He doesn't feel like eating much and hasn't been able to get out of the house. His girlfriend, Lynda, is with him and she adds that he has been getting confused about things. She is also worried about his drinking.

You ask more specific questions and:

• No fevers
• No abdominal pain.
• No SOB or cough
• No urinary symptoms.
• He has not opened his bowels for 4 days
• No haematemesis or melaena

You go on to ask about his drinking at which point he becomes agitated and asks "is this all you doctors care about? Has Lynda put you up to this?"

You go on to examine him

T 37.3C, GCS 15, AMTS 8/10

Mild asterixis/ hand flap, tattoos to forearms

Spider naevi to chest

Chest clear RR 16 bpm

HS 1+2+0 HR 100 bpm, BP 105/ 65, CR 2 secs

Abdomen soft, non tender and possibly distended. ? shifting dullness. Hepatomegaly.  Bowel sounds heard.

Joel and Lynda start to get agitated with how long everything is taking and want to go home.

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