MKSAP: 32-year-old woman with progressive jaundice
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a 10-day history of malaise, right upper quadrant discomfort, and progressive jaundice. She has had no recent travel outside of the United States, does not drink alcohol, and has no recent ingestions of drugs, including acetaminophen or herbal remedies. Up until this time, she has been healthy. She has a history of type 1 diabetes mellitus for which she takes insulin glargine and insulin detemir. She has no other medical problems.
On physical examination, temperature is 37.5 °C (99.5 °F), blood pressure is 106/68 mm Hg, pulse rate is 90/min, and respiration rate is 18/min. BMI is 24. Mental status is normal. Jaundice and scleral icterus are noted. Abdominal examination reveals tender hepatomegaly.
Laboratory studies:
INR
0.9 (normal range, 0.8-1.2)
Albumin
3.8 g/dL (38 g/L)
Alkaline phosphatase
220 units/L
Alanine aminotransferase
920 units/L
Aspartate aminotransferase
850 units/L
Total bilirubin
14.4 mg/dL (246.2 µmol/L)
Direct bilirubin
10.6 mg/dL (181.3 µmol/L)
Abdominal ultrasound demonstrates hepatic enlargement with edema surrounding the gallbladder. There is no biliary ductal dilatation. The portal vein and spleen are normal.
Which of the following is the most likely diagnosis?
A. Acute viral hepatitis
B. Fulminant liver failure
C. Hemochromatosis
D. Primary biliary cirrhosis
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Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions GI Infectious disease Source Type: blogs
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