ABSTRACT

Sarah assumed a puzzled expression. ‘Oh, the clotting,’ she finally deduced.

‘Exactly.The INR in particular is vital. It’s like an honorary LFT and if you think the liver is up the spout, you should get an INR as well as the traditional LFTs. Clotting factors are one of the first things to suffer if the liver’s struggling and the INR will pick that up. As you can see, we’re also getting an FBC. If the clotting’s deranged, you need to know whether the platelets are adequate and vice versa. Pre-existing anaemia won’t help the situation either. U and Es check out the renal function. Has hepatorenal syndrome developed and how are the kidneys doing now, in case things deteriorate? You need the glucose because the liver has an important role in maintaining blood glucose and you should always have in the

experience acute medical on-calls. As usual, the medical admissions unit was full, packed with patients suffering from ischaemic heart disease, CVAs and COPD. Interspersed were assorted presentations of malignant tumours, acute or chronic confusion and a scattering of other diseases. It was to one of this last group that Dr Juliet Smith was taking Sarah.