Jaundice — Approach and Differential

A 52-year-old man with a 10-year history of alcohol use presents with jaundice, hepatomegaly, and ascites. Serum bilirubin is 4.2 mg/dL (conjugated 3.1 mg/dL), ALT 58 U/L, AST 95 U/L, ALP 120 U/L. Prothrombin time is prolonged. Which investigation is most appropriate to confirm the suspected diagnosis of cirrhosis and assess its severity?

A 52-year-old man with cirrhosis presents with jaundice. Laboratory tests show: serum bilirubin 5.2 mg/dL (direct 4.1 mg/dL), ALP 110 U/L, ALT 68 U/L, albumin 2.8 g/dL, INR 1.8. Ultrasound shows cirrhotic liver with patent portal vein. A 35-year-old woman with painless progressive jaundice for 3 weeks presents with: serum bilirubin 8.4 mg/dL (direct 7.9 mg/dL), ALP 420 U/L, ALT 95 U/L, albumin 3.8 g/dL, INR 1.0. Ultrasound shows dilated intrahepatic and extrahepatic bile ducts with a mass at the pancreatic head. Which single finding best distinguishes intrahepatic cholestasis (cirrhosis) from extrahepatic obstruction (pancreatic cancer)?

A 38-year-old woman presents with jaundice, dark urine, and pale stools for 5 days. She has no fever, abdominal pain, or pruritus. On examination, she is afebrile, with mild hepatomegaly and no splenomegaly. Laboratory findings: total bilirubin 8.2 mg/dL (direct 6.8 mg/dL), AST 580 U/L, ALT 620 U/L, ALP 95 U/L, INR 1.1. Abdominal ultrasound shows normal bile ducts, no gallstones, and normal pancreas. Serology: anti-HAV IgM positive, anti-HBc IgM negative, anti-HCV negative. What is the most likely diagnosis?

A 52-year-old man with a 20-year history of alcohol use presents with jaundice, ascites, and spider angiomata. Serum bilirubin is 4.2 mg/dL (predominantly unconjugated), ALT 45 U/L, AST 120 U/L, ALP 95 U/L, and albumin 2.8 g/dL. Abdominal ultrasound shows cirrhosis with patent portal vein. What is the most appropriate next step in management?

In the classification of jaundice, which of the following is a characteristic feature that distinguishes unconjugated hyperbilirubinaemia from conjugated hyperbilirubinaemia?