Surgery

Last updated on: October 19th, 2021

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A 59-year-old man presents with intermittent epigastric pain and jaundice for one month. His urine slowly turned dark over the same period. He lost five kilograms of weight over the last three months. His medical and surgical histories are unremarkable. He is not on any medications, including over-the-counter drugs or herbal supplements. There is no family history of malignancies. He has a 40-year pack history of smoking. He has had an average of one to two standard drinks daily for the past decade. A full blood count and renal profile are within normal parameters. However, a liver profile is significant for alkaline phosphatase (ALP): 467 U/L (normal: 45-115), gamma glutamyl transferase (GGT): 321 U/L (normal: 9-48), total bilirubin: 2.3 mg/dL (normal: 0.1-1.3), and direct bilirubin: 2.1 mg/dL. Transaminases, serum albumin and INR are normal. Serum amylase and lipase are normal.