1. A 50-year-old intravenous drug user has increasing jaundice. Liver function tests reveal a total bilirubin of 7.8 mg/dl, direct bilirubin of 6.7 mg/dl, AST of 330 U/L, ALT of 450 U/L, and alkaline phosphatase of 80 U/L. A liver biopsy demonstrates disruption of the limiting plate of hepatocytes around the portal triads with piecemeal necrosis:
ANSWER: C - Hepatitis B and C are frequent infections associated with injection drug use, though many are subclinical.
2. While working up the cause for sudden onset of sharp right upper and lower quadrant abdominal pain in a 26-year-old woman, an abdominal ultrasound reveals the presence of a well-circumscribed 3 cm mass in the left lobe of the liver, as well as an enlarged right fallopian tube. Her HCG test is positive and ectopic pregnancy is diagnosed, even though the patient claims she has been taking oral contraceptives for 10 years:
ANSWER: G - Hepatic adenomas are rare benign neoplasms of the liver, but can be seen in patients who take oral contraceptives.