C09989691 / invoice 10000

Reason: Recheck - Bloods & UrineNotes: GLHistory: Veera presents today for recheck of liver markers and urine.8/12: AUS revealed normal liver size and echogenicity, but moderate right hepatic lymphadenopathy, most likely due to reactive hyperplasia. External biochemistry reported persistent hepatopathy (TBIL 8 umol/L; AST 318 U/L; ALT 1928 U/L; GGT 34 U/L; ALKP 763 U/L).10/12 Veera underwent laparoscopic hepatic biopsies. PT/APTT prior to procedure WNL. Liver copper returned 8.3 mmol/kg equivalent to 1,952 ppm copper. Histopathology: moderate chronic hepatitis with individual hepatocyte necrosis, mild fibrosis on trichome stain with no bridging fibrosis. Copper stain especially prominent in centrilobular hepatocytes (3-4/5). Culture negative. Recommended to commence treatment with copper chelation, liver diet, supplementary protein, hepatoprotectants.23/12/25 – mild lethargy, single V+, occasional reverse sneezing. APOCUS NSF, USG 1.040, UA pH 7.0, trace protein, BIL 2+, remainder WNL. Commenced D-penicillamine (62.5mg PO BID), transitioned to liver diet. Ordered SAMe.7/1/26 - Reported to be very well at home; bright and eating well. Fully transitioned to a liver diet plus tofu (10g/day). - Experienced mild nausea for 2-3 days following the previous visit, which was well-managed with ondansetron. Ondansetron is now only being used intermittently. No vomiting reported. Defecation and urination are normal. Awaiting delivery of SAMe, to be started upon arrival. Cystocentesis performed - USG 1.038, U/A trace protein and resolution of bilirubinuria. QML CBC MBA identified improvement in serum hepatic biomarkers. Bilirubin: 7 umol/L (0-4) AST: 267 U/L (1-80) ALT: 1626 U/L (1-80) Alkaline Phosphatase: 631 U/L (1-182)24/1/26 – Presented to ECC for vomiting. AFAST NSF. Managed as an outpatient with Ondansetron OTM dispensed.19/02/26 - Presented after ingesting a small volume of diluted coffee ground water. Exact volume in unable to be determined, however given coffee had already pressed through coffee machine, most of the caffeine would have been extracted. Activated charcoal was administered in clinic and at home, with ondansetron to be given PRN for nausea. Today, OR every 1-2 days he has a v+, white frothy (leaves yellow stain) with no food or sometimes has grass eaten. No pattern of occurrence. OR otherwise well, no other CSx after coffee ground ingestion. Still on liver diet with 100g tofu.EDDU noirmal.Would like a script ondansetron.Current Medications: D-penicillamine 62.5mg PO BID (on an empty stomach)Ondansetron OTM - once every morningDenamarin PO SID Physical Exam: T: NT P: 100 R:  pantMM:  pigmented  CRT: 1-2sBW 6.6BCS 5/9MCS 3/3Thorax: no murmur or arrhythmia, lung fields clear bilaterallyAbdo: comfortable on palpation, no overt organomegalyLN: WNLEENT: all clear with minimal clear ocular dischargeIntegument: full coat, no dermal lesions apparentMSK: ambulates well, full exam NPNeuro: appropriate mentation, full exam NPHydration: euhydratedAssessment: Veera appears well today on recheck, with the occasional vomit potentially caused by his hepatopathy, or by eating indiscriminately. He is otherwise well, so no further intervention is needed at this stage.Urinalysis is Plan:    Vital Signs    Weight: 6.6;