You assess a 28-year-old male who has relocated and is referred by his primary care physician for evaluation of jaundice. Laboratory findings indicate elevated conjugated bilirubin levels with normal haptoglobins. A liver biopsy is conducted, revealing the presence of dark granules within the hepatocytes. What is the most appropriate diagnosis for this presentation?
A 25-year-old woman in her third trimester of pregnancy presents with worsening generalised itching over the past 2 weeks, along with anorexia and malaise. She has no significant medical history, takes no medications, and is a non-smoker who drank 10 units of alcohol per week before pregnancy.
On examination, she appears well, with icteric sclerae but no visible skin rashes. Her abdomen is distended, and blood tests reveal low haemoglobin, elevated bilirubin, alkaline phosphatase, aspartate transaminase, gamma-glutamyl transferase, and prothrombin time.
What is the most likely diagnosis?
A 42-year-old woman is referred to the clinic for evaluation. She is overweight with a BMI of 31. Her primary care physician (PCP) has noticed that she has an elevated ALT of 98 U/l (5-35); a similar rise in AST is also observed. She admits to drinking 3 glasses of wine on weekends, but abstains from alcohol during the week due to her job as a teacher.
Her fasting blood glucose is measured at 5.8 mmol/l, and her HDL cholesterol is 0.6 mmol/l. Hepatic ultrasound reveals a hyperechogenic liver image. Liver biopsy reveals steatosis and evidence of inflammatory infiltrates.
What is the most probable diagnosis in this scenario?
A 25-year-old Nigerian living in London complains of pain in the upper right quadrant of the abdomen, which worsens when taking a deep breath. She reports normal bowel movements but has been experiencing night sweats that have become more frequent over the past 4-6 weeks. Upon examination, she feels warm, has a tender enlarged liver, and a dull sound on the right side of her chest. Her temperature is 38.8 °C, and her chest X-ray shows an elevated right hemidiaphragm. Her white blood cell count is elevated, and her albumin levels are slightly low, but her liver function tests and clotting results are normal. What is the most probable diagnosis?
A 28-year-old refugee from Cambodia presents with a recent onset of fatigue and jaundice. He has been living in the United Kingdom for the past year. His mother passed away from liver disease at the age of 55, and his older brother died from liver cancer three years ago in Cambodia at the age of 41. The brother was known to have hepatitis B. The patient consumes 30-40 units of alcohol per week.
Lab results show a high serum bilirubin level, elevated liver enzymes, and positive HBsAg and HBeAg. An ultrasound scan of his liver shows mild hepatomegaly and an echogenic liver but no other abnormality.
What is the most likely diagnosis?
A 38-year-old woman has presented to the hospital with a range of symptoms that vary day by day, but are consistently related to eating. She reports experiencing early satiety, nausea, and bloating, as well as diaphoresis, flushing, and palpitations. Given her medical history of poorly-controlled type 2 diabetes mellitus, obesity, anxiety, and a proximal Roux-en-Y bypass five months ago, dumping syndrome is suspected. What additional feature would support this diagnosis?
A 59-year-old female presents to the clinic with a 6 month history of diarrhoea and abdominal pain. She has a past medical history of gastric cancer which was treated with a gastrectomy. She takes no regular medicines as she doesn’t like taking drugs.
Blood results are as follows:
Hb 110 g/l
Na+ 138 mmol/l
Bilirubin 24 µmol/l
Platelets 355 * 109/l
K+ 3.8 mmol/l
ALP 88 u/l
WBC 8.6 * 109/l
Urea 6.8 mmol/l
ALT 44 u/l
Neuts 5.6 * 109/l
Creatinine 48 µmol/l
γGT 105 u/l
Albumin 38g/l
Eosin 0.2 * 109/l
CRP 4 mg/l
Anti TTG negative
Faecal calprotectin negative
A blood film and haematinic screen was requested:
Blood film Microcytes, macrocytes, hypersegmented neutrophils
MCV 85 fl
Red blood cell distribution width Markedly elevated
B12 100 ng/l (low)
Folate 22.2 nmol/l (normal)
Ferritin 80 µg/L (low)
What is the most likely diagnosis?
A 60-year-old woman complains of a gradual onset of difficulty swallowing, first with solid foods and then with liquids, over the course of one month. She is uncertain if she has experienced any weight loss. The patient has no prior medical history, but she is a smoker and denies regular alcohol consumption. Upon examination, she appears thin and pale, with a soft and non-tender abdomen and no palpable masses. What is the probable underlying diagnosis?
A 65-year-old man is experiencing reflux and is currently on multiple medications for various health issues. Which of the following drugs has the potential to decrease the pressure of the lower esophageal sphincter?
A 67-year-old man has been referred for a medical opinion by the surgical team. He underwent an elective open repair of an abdominal aortic aneurysm two days ago and is currently taking regular paracetamol, atorvastatin, and morphine. Ramipril and bisoprolol were recently discontinued. On examination, he appears pale with no signs of chronic liver disease. His pulse is 66 beats per minute and blood pressure is 100/40 mmHg. Yesterday, his liver function tests showed significant abnormalities, including low albumin levels, high bilirubin levels, and elevated ALT, AST, and ALP levels. His INR was also slightly elevated. Prior to admission, his liver function tests were normal. What is the most likely cause of his abnormal liver function tests?