Question 32

54 year male patient comes to the ER with pain in abdomen. The pain is present since a week, but it is become so severe now that he had to rush to the ER. He also gives history of having pain in his calves for the last week. On examination, he has a palpable liver and spleen. There is shifting dullness present. He also gives history of severe itching after taking showers, and had been on allopurinol for Gout since a few months. His Liver enzymes are raised and PT is 24 with an INR of 2.0, Hb is 17 gm%, and Hct is 60. He has a remote history of alcohol dependence, and smokes 2 - 3 cigerettes per day for last 10 years. He lives with his only sexual partner for the last 30 years and occassionally uses condoms. He has never been treated with any STDs. What is pathological cause of his condition at present?

a) Peliosis hepatis

b) Myeloproliferative diseases

c) Alcoholism

d) CBD obstruction

e) Hematobilia