Routine Evaluation in Medicine / Internal Medicine — 40yo Woman | Hepatology | SMLE Q#2049

SMLE Question #2049

Medicine / Internal Medicine Hepatology

Objective: OBJ-HEP-01

Last updated: January 2026
A 40-year-old woman comes to the clinic for routine evaluation. She feels well and denies abdominal pain, weight loss, pruritus, fever, or change in bowel habits. On examination, she has scleral icterus and mild jaundice but no abdominal tenderness or palpable mass. Laboratory studies show: total bilirubin 6.0 mg/dL, direct (conjugated) bilirubin 4.8 mg/dL, ALT 320 U/L, AST 210 U/L, ALP 130 U/L. An abdominal ultrasound shows no biliary ductal dilatation and a normal-appearing pancreas. What is the most likely diagnosis?

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