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25th July 2024
A 42-year-old female presents to A&E with acute-onset jaundice, right upper quadrant pain
A 42-year-old female presents to A&E with acute-onset jaundice, right upper quadrant pain and abdominal swelling. She reports intermittent episodes of dark urine. She has no significant past medical history and takes no regular medications. She drinks around 18 units of alcohol a week and does not smoke.
On examination, she has pale conjunctiva, moderate ascites and a palpable liver and spleen. There is also left leg swelling consistent with a deep vein thrombosis (DVT). She reports shortness of breath on exertion but her observations at rest are within normal range.
Blood tests show:
| Hb (115 – 165 g/L) | 99 g/L |
| WCC (3.6 – 11.0 x 10⁹/L) | 9.3 x10⁹/L |
| Platelets (140 – 400 x10⁹/L) | 68 x10⁹/L |
| Bilirubin (<21 μmol/L) | 91 µmol/L |
| ALT (<41 U/L) | 520 U/L |
| ALP (30–130 U/L) | 245 U/L |
| Albumin (35–50 g/L) | 29 g/L |
| LDH (240–480 U/L) | 820 U/L |
Which investigation is most likely to find the underlying diagnosis?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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