MRCP2-1788
A 65-year-old man with a history of heavy alcohol consumption for over three decades presents to the emergency department with pain in the upper right abdomen and epigastric region. He reports feeling nauseated and has vomited multiple times. He also complains of profuse sweating and feeling very hot. Despite his symptoms, he continued to drink alcohol up until his admission.
During his medical history, he recalls being advised to undergo gallbladder surgery by a surgeon in the past, but he cannot remember the details as he left the hospital against medical advice.
Upon examination, the patient appears flushed and has a fever of 38°C. His blood pressure is 120/70 mmHg, and his pulse rate is 100 beats per minute. His sclera are yellow, and he has eight spider naevi on his upper torso. Heart sounds are normal, and his chest is clear upon auscultation. His abdomen is tender in the right upper quadrant, but no mass is palpable. There is no detectable ascites, and rectal examination is unremarkable.
Laboratory investigations reveal abnormal results, including elevated liver enzymes, high white blood cell count, and an elevated international normalized ratio. His serum albumin is low, and his total bilirubin is high.
What is the most likely diagnosis for this patient?