A patient with alcoholic liver disease may develop a cholestatic syndrome. Taking the patient to surgery for presumed large duct obstruction may be followed by hepatic and/or renal failure.


Clinical features:

(1) right upper quadrant pain and tenderness

(2) jaundice

(3) hepatomegaly

(4) recent excessive alcohol use (may be denied)


Laboratory features:

(1) elevated serum alkaline phosphatase

(2) elevated serum total bilirubin


Imaging findings:

(1) negative ultrasound for stones and obstruction

(2) negative ERCP

(3) negative transhepatic cholangiography


Liver biopsy findings:

(1) alcoholic steatohepatitis or cirrhosis

(2) bile plugs in canaliculi

(3) variable cholangitis

(4) negative for findings of large duct obstruction


Problems in diagnosis may occur if the patient also has:

(1) cholelithiasis OR

(2) pancreatitis


Differential diagnosis:

(1) viral hepatitis

(2) cholestatic drug reaction

(3) non-alcoholic steatohepatitis


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