23rd July 2023

A 54-year-old man presents to A&E with abdominal pain and swelling

A 54-year-old man presents to A&E with abdominal pain and swelling. This has been progressive over the last few weeks, and more recently, he has been feeling short of breath. He has had no fevers or change in bowel habit. He denies any weight loss, in fact, he seems to have gained weight.

He has a past medical history of asthma. He drinks 2 bottles of beer per day, and injects heroin. He is an ex-smoker with a 10-pack-year history.

Examinations findings are consistent with ascites, but there is no tenderness.

Blood results are as follows:

• Haemoglobin 121 g/L (130-180g/L)
• White cell count 6.4 x 10⁹/L (3.6 – 11.0 x 10⁹/L)
• AST 84 u/L (1-45 u/L)
• ALT 182 u/L (<42 u/L)
• ALP 64 u/L (30-130 u/L)
• Bilirubin 38μmol (<21μmol)

The patient undergoes a CT scan which shows a small liver with an irregular border.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.