A 42-Year-Old Man Comes to the Office Due to Progressive

question 453

Multiple Choice

A 42-year-old man comes to the office due to progressive fatigue, nausea, and itchiness.  On review of systems, the patient admits that he occasionally has bloody stools.  Medical history is unremarkable.  Examination shows scleral icterus.  Percutaneous liver biopsy is performed, and histologic analysis of the tissue sample reveals fibrous obliteration of intrahepatic small bile ducts with concentric replacement by connective tissue.  Which of the following is the most likely diagnosis?

• A)Autoimmune hepatitis
• B)Cytomegalovirus infection
• C)Hemochromatosis
• D)Primary biliary cholangitis
• E)Primary sclerosing cholangitis

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