A 43-year-old woman presented to the hospital with the chief complaint of severe and poorly localized abdominal pain. The pain lasted for a month, and she also noticed the rapid onset of pale and yellow skin, swelling in both legs, and tea-colored urine. The woman had developed chronic hepatitis B infection and did not follow up regularly. Physical examination: The patient looked acutely ill with icteric sclera, skin, and mucus membrane.
Abdominal examination revealed palpable spleen and liver contour with shifting dullness. There was no muscle rebounding or guarding pain. Laboratory examination: Total leukocyte count: 9,060 cells/μL Hemoglobin: 12.1 g/Dl Platelet count: 243,000/μL Alanine transaminase (ALT): 127 U/L Aspartate aminotransferase (AST): 268 U/L Alkaline phosphatase (ALP): 468 U/L Serum total bilirubin: 2.9 mg/dL (direct fraction 1.1 mg/dL) Albumin: 3.2 g/Dl Creatinine:…
