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27th February 2025
A young woman with a history of diarrhoea and bloating ongoing for several years presents to her GP.
A young woman with a history of diarrhoea and bloating ongoing for several years presents to her GP. She undergoes investigations which confirm a diagnosis of coeliac disease. She also tells you that she has found herself becoming more fatigued with aches and pains in her arms and legs.
On examination, she has mild weakness and tenderness, predominantly in her upper arms.
You also notice a rash consisting of raised red blisters, which appear to be symmetrical on both elbows. When you ask about the rash, she tells you it has recently come up.
| Sodium | 137 mmol/L | 135-145 mmol/L |
| Potassium | 3.7 mmol/L | 3.5-5.3 mmol/L |
| Urea | 4.5 mmol/L | 2.5-6.7 mmol/L |
| Creatinine | 93 μmol/L | 70-100 μmol/L |
| ALT | 38 IU/L | 5-35 IU/L |
| ALP | 178 IU/L | 30-130 IU/L |
| Bilirubin | 14 μmol/L | 3-17 μmol/L |
| Corrected calcium | 1.90 mmol/L | 2.12-2.60 mmol/L |
| Phosphate | 0.60 mmol/L | 0.80-1.40 mmol/L |
What is the next most appropriate investigation?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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