26th February 2025

You are asked to review a 29-year-old gentleman of Iranian origin in the emergency department.

You are asked to review a 29-year-old gentleman of Iranian origin in the emergency department. He has been experiencing significant abdominal pain, which has been getting worse over the last 2 weeks. The pain is worst in the right upper quadrant. He has been opening his bowels normally and feels slightly nauseous but has not been vomiting. He has had very little appetite recently, although he feels this may be due to some sores in his mouth that have made it difficult to eat.

On examination there is tenderness in the right upper quadrant with hepatomegaly. The abdomen is soft; however, feels slightly distended, and there is evidence of shifting dullness. Bowel sounds are present.

You take his blood tests and notice an ulcer on his arm where he has previously had a blood test performed in A&E. The results are shown below:

US abdomen: the liver is enlarged with a heterogenous echotexture. Using Doppler modality, there is no flow visualised in the right hepatic vein.

What is the most likely diagnosis?

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