A 45-year-old farmer from sub-Saharan Africa presents with weight loss, abdominal distension, and right upper quadrant pain. His medical history is significant for chronic hepatitis B infection. He mentions consuming home-stored maize regularly. Imaging reveals a liver mass with arterial enhancement and venous washout. His alpha-fetoprotein (AFP) level is elevated. What is the most likely environmental carcinogen contributing to this patient’s hepatocellular carcinoma?
A 32-year-old man with a 5-year history of ulcerative colitis (UC) presents to the clinic with complaints of eye pain, redness, and blurred vision over the past few days. He also reports a recent onset of joint pain and stiffness, particularly in his lower back, that worsens in the morning and improves with activity. He mentions intermittent painful red nodules on his legs and has had jaundice and fatigue for the last few weeks. On examination, his sclerae are injected, and there is tenderness over the sacroiliac joints. His skin shows erythematous, tender nodules on the anterior shins. Laboratory tests reveal elevated alkaline phosphatase and gamma-glutamyltransferase (GGT). Which of the following is an extraintestinal manifestation of ulcerative colitis?
A 50-year-old man with a 15-year history of primary sclerosing cholangitis presents with worsening fatigue and jaundice. CA 19-9 levels are elevated, and imaging shows a mass in the common bile duct. What is the most likely diagnosis?
A patient diagnosed with primary sclerosing cholangitis consults with a hepatologist about the risk of developing other diseases. The patient wants to know what other conditions they might be at higher risk for. Which of the following cancers has an increased incidence in patients with primary sclerosing cholangitis?
A 35-year-old woman presents with fatigue and itching. She has no significant past medical history. Laboratory tests reveal elevated ALP, GGT, and total bilirubin. Anti-mitochondrial antibodies (AMA) are negative. MRCP shows a beaded appearance of the bile ducts. Which associated condition is most likely in this patient?
Patient Case: A young woman with recently diagnosed PSC is discussing treatment options with her physician. She asks about the primary medical management for PSC to potentially slow disease progression. Which of the following is considered the first-line medical treatment for PSC to manage symptoms and potentially slow progression?
Case Prelude: A 34-year-old man presents to the clinic with a 6-month history of fatigue, generalized itching, and intermittent right upper quadrant abdominal discomfort. He also reports yellowing of his eyes for the past 2 weeks. His medical history is significant for ulcerative colitis diagnosed 10 years ago, for which he takes mesalamine. He denies fever, chills, weight loss, or changes in bowel habits. Physical Examination: Vitals: Blood pressure 120/80 mmHg, heart rate 80 bpm, temperature 36.8°C. General Appearance: Scleral icterus noted. Abdomen: Mild tenderness in the right upper quadrant without rebound or guarding. No hepatosplenomegaly or ascites. Skin: Evidence of excoriations due to scratching. Investigations: 1.Laboratory Tests: Elevated alkaline phosphatase (ALP): 550 U/L (normal: 44–147 U/L). Elevated gamma-glutamyltransferase (GGT): 120 U/L. Mildly elevated ALT: 90 U/L (normal: 10–40 U/L). Total bilirubin: 3.5 mg/dL (normal: 0.1–1.2 mg/dL). Positive p-ANCA antibody. 2.Imaging: Magnetic Resonance Cholangiopancreatography (MRCP): Irregular intrahepatic and extrahepatic bile ducts with alternating strictures and dilations (“beaded appearance”). 3.Colonoscopy: Active inflammation consistent with ulcerative colitis. What is the most likely diagnosis?
A 52-year-old woman presents to the emergency department with severe right upper quadrant abdominal pain and jaundice. History of Present Illness: The patient reports experiencing intermittent episodes of dull abdominal pain over the past few weeks, which she attributed to fatty meals. However, 24 hours ago, the pain became severe, constant, and radiated to her back. She noticed her urine turning dark and her stools becoming pale. She denies fever, nausea, or vomiting. Past Medical History: •Gallstones diagnosed 2 years ago (no prior intervention). •Hypertension, controlled with medication. Social History: •Non-smoker, occasional alcohol use. •Works as a teacher and denies recent travel. Physical Examination: •Vital signs: BP 125/80 mmHg, HR 96 bpm, Temp 98.7°F, RR 18 breaths/min. •General: Appears uncomfortable but alert. •Abdominal exam: Marked tenderness in the right upper quadrant, positive Murphy’s sign, no palpable masses. •Skin: Icteric sclera and mild jaundice.Laboratory Findings: •Liver enzymes: ALT 150 U/L, AST 130 U/L, ALP 420 U/L, GGT 350 U/L. •Bilirubin: Total 4.8 mg/dL (direct 3.8 mg/dL). •WBC: 8,000/mm³. •Lipase: Normal. Imaging: • Abdominal ultrasound: Dilated common bile duct (CBD) measuring 10 mm, no clear stones visualized. MRCP confirms the presence of a CBD stone. What is the definitive treatment for her condition?
A 60-year-old man with known gallstones presents with fever, chills, severe abdominal pain, and jaundice. His blood pressure is 90/60 mmHg, and he is tachycardic. Lab tests show leukocytosis, elevated bilirubin, alkaline phosphatase (ALP), and gamma-glutamyl transferase ( GGT) Which complication of choledocholithiasis is most likely in this patient?
A 45-year-old woman presents with severe right upper quadrant pain radiating to the back, jaundice, and nausea. She reports dark urine and pale stools over the past two days. Physical examination reveals tenderness in the right upper quadrant. Lab tests show elevated alkaline phosphatase (ALP) , gamma-glutamyl transferase ( GGT), and conjugated bilirubin. What is the most likely initial imaging modality to confirm the diagnosis?