MSRA-0712

A 50-year-old man presents to the emergency department with right upper quadrant pain, fatigue, and anorexia that has been going on for a few weeks and is getting gradually worse. His past medical history includes heavy alcohol intake, gastroesophageal reflux disease (GORD) and a hiatus hernia. He only takes omeprazole and has no known allergies.

On examination, he looks jaundiced.

A liver function test is done which shows:

Bilirubin 50 µmol/L (3 – 17)
ALT 150 u/L (3 – 40)
AST 300 u/L (8 – 33)
Albumin 35 g/L (35 – 50)

What is the most likely diagnosis?