QuestionSBA
QuestionChoice
Hepatitis B leads to damage to the hepatocytes - thus causing a hepatic picture in the LFTs, which is not seen in this patient's results. Instead, an obstructive pattern is seen with raised bilirubin, GGT and ALP, alongside a lesser rise in ALT. These results, alongside right upper quadrant pain, jaundice and pale stool, are consistent with biliary obstruction. Considering her age and gender, gallstones are the most likely cause of this obstructive picture.
10000702
b
Hepatitis B
QuestionChoice
The LFTs of this patient show an obstructive pattern, with raised GGT and ALP, alongside a lesser rise in ALT. Additionally, the right upper quadrant pain is consistent with biliary obstruction - which would also explain her jaundice. The presence of pale stools in her history also means that the cause of this obstruction is likely post-hepatic. Gallstones are the most common cause of biliary obstruction, and are post-hepatic. As she has no red flags for metastases, gallstones are the most likely diagnosis.
10000701
a
Gallstones
QuestionChoice
Alcoholic hepatitis would lead to hepatocellular disease and cause a hepatic picture in the LFTs, which is not seen in this patient's results. Instead, an obstructive pattern is seen with raised bilirubin, GGT and ALP, alongside a lesser rise in ALT. These results (alongside right upper quadrant pain, jaundice and pale stool) are consistent with biliary obstruction. Considering her age and gender, gallstones is the most likely cause of this obstructive picture.
10000703
c
Alcoholic hepatitis
QuestionChoice
Primary sclerosing cholangitis may produce an obstructive LFT picture as it causes obstruction to the flow of bile out of the liver. It would also present with obstructive jaundice and right upper quadrant pain, and may cause pale stools. It is a differential diagnosis for this patient, and should be excluded via imaging. However, gallstones are by far the most common cause of biliary obstruction, especially in women around the age of 40 years. Therefore, gallstones are the most likely diagnosis.
10000705
e
Primary Sclerosing Cholangitis
QuestionChoice
Gilberts Syndrome is an inherited, pre-hepatic, cause of jaundice that causes an isolated rise in bilirubin. This would not explain any of this patient's other symptoms e.g. pale stools and right upper quadrant pain. It also does not explain the derangement of any of her other LFTs.
10000704
d
Gilberts Syndrome
Concept
Chapter
2693
3810
Gallstone Disease
Topic
135
General surgery
12687
Picture
1508
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NOcFE4JmZniAiAh3h3BwCAc=
Topic
135
General surgery
A 36-year-old female presents with right upper quadrant pain and jaundice. From her history, you find out that her stool has also been pale in recent weeks. Her LFT results are shown below.

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Which of the following is her most likely diagnosis?
a