A 68-year-old woman presents with two days of constant right upper quadrant and epigastric pain. Overnight she had two episodes of violent, uncontrollable shaking each lasting several minutes, and this morning her daughter noticed her eyes looked yellow. On examination her temperature is 38.9°C, pulse 112/min and blood pressure 98/64 mmHg, with tenderness in the right upper quadrant but no peritonism. Investigations show bilirubin 88 µmol/L (<20), alkaline phosphatase 410 U/L (30–110), GGT 590 U/L (<38), ALT 170 U/L (<35) and lipase 45 U/L (<60). Which one of the following is the most likely diagnosis?
Keep going — a set of ten like this one, one at a time.
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