Question of the Week

For January 27, 2015

A 30-year-old previously healthy woman with a BMI of 30 presents to the emergency department reporting 6 hours of mid-epigastric pain that radiates to her right shoulder. Physical examination reveals tachycardia and mild mid-epigastric tenderness.

Laboratory testing reveals a normal serum amylase level and the following abnormal results:

Patient value

Reference range

Aspartate aminotransferase (U/liter)

180

0–35

Alanine aminotransferase (U/liter)

190

0–35

Alkaline phosphatase (U/liter)

200

30–120

Total bilirubin (mg/dL)

5.0

0.3–1.0

Ultrasound of the right upper quadrant reveals a liver with coarse echotexture, a dilated common bile duct, and a contracted gallbladder that does not contain any visible stones.

Which one of the following conditions is the most likely cause of this patient’s symptoms?

Choledocholithiasis
Nonalcoholic fatty liver disease
Cholecystitis
Tumor of the pancreatic head
Autoimmune hepatitis