A 54-year-old male with a history of cirrhosis due to alcohol abuse presents with malaise and decreased urine output. Upon examination, he appears jaundiced and his catheterized urine output is only 5 ml per hour. Laboratory results show low urinary sodium and elevated urine osmolality compared to serum osmolality. Blood tests reveal elevated liver enzymes, bilirubin, and creatinine. What is the probable diagnosis?
A 55-year-old woman comes to her GP complaining of fatigue, weakness, and worsening itchiness. Upon examination, there are no significant findings. Blood tests are ordered and the results are as follows:
Test Result
Full blood count Normal
Renal profile Normal
Alkaline phosphatase Elevated
γ-glutamyl transferase Elevated
Alanine and aspartate aminotransferase Normal
Bilirubin Slightly elevated
Antimitochondrial antibody M2 (AMA) Positive
Anti-smooth muscle antibody (ASMA) Negative
Anti-liver/kidney microsomal antibody (anti-LKM) Negative
Hepatitis screen Negative
HIV virus type 1 and type 2 RNA Negative
What is the most probable diagnosis?
A 22-year-old student is admitted to hospital after being referred by her general practitioner. She has been feeling nauseous and generally unwell for 1 week. Yesterday she became concerned because her skin had turned yellow. There is no past medical history of note and there is no history of intravenous (iv) drug use, blood transfusions or unprotected sexual intercourse. She has recently returned from backpacking in Eastern Europe. Viral serology is requested, as well as liver function tests which are reported as follows:
total bilirubin 90 mmol/l
aspartate aminotransferase (AST) 941 ui/l
alanine aminotransferase (ALT) 1004 iu/l
alkaline phosphatase 190 u/l.
What is the most likely diagnosis?
A 33-year-old former intravenous (iv) drug abuser presents to outpatient clinic with abnormal liver function tests (LFTs) at the recommendation of his general practitioner. Although he is not experiencing any symptoms, a physical examination reveals hepatomegaly measuring 4 cm. Further blood tests confirm that he is positive for hepatitis C, with a significantly elevated viral load of hepatitis C RNA. What would be the most crucial investigation to determine the appropriate management of his hepatitis C?
A 50-year-old Chinese man arrives at the Emergency Department with a swollen belly. He reports experiencing weight loss and a dull ache in his right upper abdomen. Upon examination, he appears sweaty and has a tender enlarged liver with fluid buildup. His temperature is 38 °C and blood tests indicate elevated levels of α-fetoprotein. An ultrasound of his liver reveals areas of abnormal tissue growth. What is the probable primary liver cancer diagnosis based on these findings?
A 7-year-old child is brought to the paediatrician by his parents for a follow-up examination after diagnosis of a genetically inherited disease. During the examination, the paediatrician observes a yellow-brown discoloration around the iris.
Which type of renal dysfunction is typically treated as the first-line approach for this child’s condition?
A 50-year-old alcoholic with known cirrhotic liver disease is admitted to the Gastroenterology Ward with a distended abdomen, jaundice and confusion. During examination, he is found to be clinically jaundiced and has a massively distended abdomen with evidence of a fluid level on percussion. A sample of fluid is taken from his abdomen and sent for analysis, which reveals that the fluid is an exudate.
What is an exudative cause of ascites in this case?
A 67-year-old man had a gastric endoscopy to investigate possible gastritis. During the procedure, the endoscope passed through the oesophagogastric junction and entered the stomach.
Which part of the stomach is situated closest to this junction?
A 68-year-old man presents with jaundice and a 4-month history of progressive weight loss. He denies any abdominal pain or fever. He reports pale-coloured stool and dark urine.
What is the most probable diagnosis?
A 28-year-old woman presents to the Emergency Department with a 3-hour history of abdominal pain. Upon further inquiry, she reveals a 3-week history of right-sided abdominal pain and considerable weight loss. She reports consuming 3 units of alcohol per week and has smoked for 10 pack-years. She is not taking any medications except for the contraceptive pill and has no known allergies. During the physical examination, she displays oral ulcers and exhibits signs of fatigue and pallor.
What is the probable diagnosis?