Worried About Liver Scan Results

Personal details:

Patient name: Sarah Mitchell

Patient age: 42

Medical Records:

Past medical history:

Hypertension

Depression

Current medications:

Amlodipine 5mg OD

Sertraline 100mg OD

Allergies: NKDA

Medical Notes:

GP consultation - 1 year ago:

"Sarah requesting prescription for Mounjaro (tirzepatide) for weight loss. BMI 34. Has struggled with weight for years, feels this would help. Explained Mounjaro not available on NHS for weight management at that time - awaiting NICE guidance. Discussed lifestyle modifications, dietitian referral. Patient disappointed but understood. Declined dietitian referral. Will monitor."

Nurse consultation - 3 months ago:

"Routine health check. BP 136/82. BMI 34 (unchanged from last year). Weight 90kg, height 165cm. Discussed weight management again. Blood tests requested for annual review."

GP filing note - 3 months ago:

"Blood results reviewed: LFTs abnormal. ALT 76, ALP 142, GGT 88. Other bloods normal (FBC, U&E, HbA1c, lipids, TFTs normal). Plan: Repeat LFTs in 4 weeks, arrange viral hepatitis screen and ultrasound."

GP filing note - 2 months ago:

"Repeat bloods: ALT 79, ALP 148, GGT 92 - persistent elevation. Hepatitis B, C, HIV negative. Autoantibodies negative. Ferritin normal. Abdominal ultrasound arranged."

Radiology report - 2 weeks ago:

"Abdominal ultrasound: Liver demonstrates increased echogenicity consistent with hepatic steatosis (fatty liver). No focal lesions identified. Gallbladder, spleen, pancreas, kidneys - normal appearances. Impression: Non-alcoholic fatty liver disease."

Reception note - today:

"Patient called requesting urgent appointment to discuss scan results. States she's very worried. Appointment booked for today."

Investigation Results:

Blood tests - 3 months ago:

ALT: 76 U/L (normal <45)

ALP: 142 U/L (normal <120)

GGT: 88 U/L (normal <40)

Bilirubin: 11 µmol/L (normal)

Albumin: 43 g/L (normal)

FBC: Normal, Platelets 245

HbA1c: 40 mmol/mol (normal)

Lipids: Total cholesterol 5.6, LDL 3.6, HDL 1.3, TG 1.9

U&Es: Normal

TFTs: Normal

Repeat bloods - 2 months ago:

ALT: 79 U/L

ALP: 148 U/L

GGT: 92 U/L

Hepatitis B, C, HIV: Negative

Autoantibodies (ANA, SMA, LKM): Negative

Ferritin: 145 µg/L (normal)

Caeruloplasmin: Normal

Ultrasound - 2 weeks ago:

Increased hepatic echogenicity consistent with hepatic steatosis (fatty liver)