23rd July 2023

A 37-year-old, who is generally fit and well, presents with two months of upper abdominal pain and fatigue

A 37-year-old, who is generally fit and well, presents with two months of upper abdominal pain and fatigue. He has not had any fevers, nausea, vomiting or weight loss. He does mention having intermittent diarrhoea. Physical examination is unremarkable.

Blood results:

• Haemoglobin 123 g/L (130-180g/L)
• White cell count 9.8 x 10⁹/L (3.6 – 11.0 x 10⁹/L)
• AST 84 u/L (1-45 u/L)
• ALT 52 u/L (<42 u/L)
• ALP 164 u/L (30-130 u/L)
• GGT 101 u/L (8-61 u/L)
• Bilirubin 38μmol (<21μmol)

An ultrasound of the liver shows both intra- and extrahepatic duct dilatation.

What is the most likely diagnosis?

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