Hepatobiliary Essay

You are tasked to a 64 year old lady who was found wandering the streets in her nightie confused. Her neighbours called for the ambulance because they were worried as this is not normal behavior for her.


Alert but anxious, disoriented an confused

Pale yellow tinged skin, and eye sclera

BP 145/85, HR 95, RR 24 SaO2 97%, Cap refill <2secs, Pupils size 2 EARRTL

Mild non specific Right upper quadrant tenderness, murphy?s sign positive.


Relatively fit and well, HT, Mild Asthma

Medications ? atenolol, enalapril, salbutamol inhaler

Her husband states that she has been taking a ?cleansing substance? from the local naturopath for the last week. He noticed that she was becoming increasingly forgetful, agitated and confused over the last few days.

No Smoking

Occasional alcohol

What do you know about the patient? What is the key information? What do you still need to find out?

Outline 3 provisional diagnoses.

Discuss your final diagnosis and the pathophysiology behind the diagnosis.

Discuss the implications for paramedic practice.

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