Rhian and Martin decide to set up a partnership, the aim of which is to locate a piece of land and build a number of houses upon it. A partnership agreement is drawn up. A piece of land is located that is ideal, but Rhian informs Martin that the council has refused to grant planning permission to build on the land. In fact, the land has already been granted planning permission. Rhian purchases the land without informing Martin and develops a number of houses on it. She then sells them for a considerable profit. Martin discovers this and seeks your advice regarding what action to take next. Discuss

Question 1

Please could you tell me the normal range of values for the liver function

test serum alkaline phosphatase. The only mention of the parameters is

that a reading of 1000serious liver condition.

Question 2

What is the best single test of liver function to exclude liver cell failure in

the routine work-up of a patient with early dementia?

Question 3

How valuable is the measurement of the liver span in a physical

examination?

Question 4

Why has the term 'chronic liver disease' replaced terms such as 'chronic

hepatitis'? What exactly does this new term mean and what conditions

does it cover?

Question 5

Can jaundice occur early in schistosomal hepatic fibrosis and, if so, how?

Question 6

My patient has been found to have a serum bilirubin of 34 mol/L

(2 mg/dL) on three occasions. The other liver tests are normal. He tells

me he has Gilbert's disease; how can I prove this?

Question 7

Why is urinary urobilinogen increased in haemolytic jaundice? If the

bilirubin in this condition is unconjugated, how does it reach the terminal

ileum to be converted into urobilinogen?

Question 8

How does cholestatic jaundice affect the kidney?

Question 9

What is the mechanism by which cholestatic jaundice causes

bradycardia?

Question 10

Are 'jaundice' and 'icterus' one and the same? I was taught that icterus

is yellowing of the sclera, while jaundice is yellowing of the skin and the

mucous membranes. As a result, carotenaemia can produce jaundice but

not icterus: is this so? I would be grateful if you would clarify this for me.