BOF: 120
A 20 year old
male presents with a history of abdominal discomfort and feeling generally
unwell. He also complains of passing dark urine .He says there have been
similar episodes in the past. He has no significant past medical illness and
is not on any medication. He tells you that one of his cousins has a condition
affecting the nerves and that the cousin has something like Parkinson’s
disease. He is an university student and does admit to alcoholic binges.
On examination
you note that he looks unwell is jaundiced. There are no signs of chronic
hepatocellular failure or portal hypertension. His liver is enlarged 3
fingerbreadths and is tender
Investigations:
Hb 9.6 g/dL
MCV 104
WBC 6.3 x109 /L
Platelets 200
x109/L
ALT 450 U/L
Alkaline
phosphatase 250 U/L
Bilirubin 95
µmol/L
In this patient
which one of the following is the most likely diagnosis?
a)
Wilson’s disease
b)
Alcoholic hepatitis
c)
Zieve’s syndrome
d)
Paroxysmal nocturnal haemoglobinuria
e)
Acute hepatitis C
