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20th July 2020
A 35-year-old Caucasian gentleman is seen in the Hepato-Pancreato-Biliary (HPB) clinic due to multiple hospital admissions from recurrent bacterial cholangitis
A 35-year-old Caucasian gentleman is seen in the Hepato-Pancreato-Biliary (HPB) clinic due to multiple hospital admissions from recurrent bacterial cholangitis in the past 2 years. He does not have any known past medical history. He has a known family history of Inflammatory Bowel Disease and colorectal cancer. Multiple investigations have been done in the interim which showed the following:
| Alanine Transferase (ALT) | 50 iu/l [3 – 40 iu/l] |
| Aspartate Transaminase (AST) | 40 iu/l [3 – 30 iu/l] |
| Alkaline Phosphatase (ALP) | 300 umol/l [30 – 100 umol/l] |
| y-Glutamyl Transferase (GGT) | 100 u/l [8 – 60 u/l] |
| Bilirubin | 21 umol/l [3 – 17 umol] |
| p-ANCA | Raised |
| Anti-Mitochondrial antibody | Normal |
| Transabdominal USS | No stones visible within the gallbladder or biliary tree |
| CT-Abdomen | No signs of stones and tumour mass detected around the biliary tree |
| MRCP | Multi-focal bead-like appearance within the common biliary duct |
Which of the following options is the most likely diagnosis? Select ONE answer only.
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