Hepato-biliary System: 56 y/o man with fatigue, abdominal discomfort and weight loss
Clinical Presentation:
A 56 year old man with a history of alcohol abuse and recurrent pancreatitis presents with fatigue, abdominal discomfort and weight loss of 10 lbs. over the previous 6 months. He denies vomiting, blood in the stools, or diarrhea. A social history reveals that he drinks 2-3 bottles of scotch per day and has a 60 pack year smoking history. He has chronic pancreatitis and has repeated attacks of abdominal pain every 3-4 months. Physical exam is remarkable for a palpably enlarged liver. He is not jaundiced and stool guaiacs are negative. Laboratory test results are remarkable for elevated serum AST and ALT level.