Hepatobiliary Disease USMLE Step 1 Practice Question
A 38-year-old man presents to the emergency department 48 hours after undergoing ERCP with sphincterotomy for choledocholithiasis. He reports right upper quadrant pain, nausea, and dark urine. Temperature is 38.9°C, heart rate 102/min, blood pressure 128/82 mmHg, respiratory rate 18/min. Laboratory studies show total bilirubin 4.2 mg/dL, direct bilirubin 3.8 mg/dL, alkaline phosphatase 245 U/L, ALT 156 U/L, amylase 185 U/L, and white blood cell count 11,200/μL. Abdominal ultrasound demonstrates dilated intrahepatic bile ducts with a normal-caliber common bile duct and no stones. Blood cultures are pending. Which of the following is the most likely diagnosis?
Answer choices
- AAcute pancreatitis
- BPost-sphincterotomy papillary edema with transient obstruction
- CAcute cholecystitis
- DAscending cholangitisCorrect answer
- EBile duct perforation
- FDrug-induced hepatotoxicity from sedation
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