A 50 year old lady presented with history of pain upper abdomen, nausea, and decreased appetite for 5 days. She had undergone cholecystectomy 2 years back. Her bilirubin was 10 mg/dl, SGOT 900 IU/I SGPT 700 IU/I and serum alkaline phosphatase was 280 IU/I. What is the most likely diagnosis -

Ans. is 'c' i.e., Acute viral hepatitis The serum abnormalities and the symptoms of the patient matches with those of acute viral hepatitis.Liver test pattern in alcoholic hepatitis.* Bilirubin-Both fractions may be elevated. Peak usually follows aminotransferases Bilirubinemia* Aminotransferases-Elevated ALT > AST* Alkaline-Normal to < 3 timesphosphatase normal elevation* Albumin-Normal* Prothrombin time-Usually normalSymptoms of acute viral hepatitisProdromal symptoms include - Anorexia, nausea, vomiting, fatigue, malaise, arthralgia, myelalgia, headacheThese symptoms precede the onset of Jaundice by 1-2 weeks About other options -Acute pancreatitisAcute pancreatitis does not present with these serum abnormalities.Diagnosis of acute pancreatitis is highly unlikely in the absence of elevated serum amylase.Acute cholangitisAcute cholangitis can present with the above mentioned laboratory abnormalities.Diagnosis of acute cholangitis is highly unlikely in the absence of classical clinical presentation of - pain, fever and jaundice (Charcot's triad).