Here is the paraphrased version of question 126 from the document:
**Question:**
A 40-year-old male patient presents with jaundice and fatigue but no other symptoms. He has a history of smoking and alcohol consumption. Laboratory tests show the following results: AST 147 U/L (elevated), ALT 76 U/L (elevated), Bilirubin levels are high, Ferritin is 450 µg/L (very high), TIBC is normal, Hepatitis serology is negative, ANA is positive, and ASMA is negative.
What is the most likely diagnosis?
A) Hemochromatosis
B) Alcoholic hepatitis
C) Primary sclerosing cholangitis
D) Chronic hepatitis B infection
E) Autoimmune hepatitis
**Correct Answer:** B) Alcoholic hepatitis
**Explanation:**
This patient’s elevated AST and ALT levels, in conjunction with a history of alcohol consumption and a very high ferritin level, are indicative of alcoholic hepatitis. The positive ANA and elevated ferritin might suggest an autoimmune process or iron overload, but in the context of the patient’s history and lab findings, alcoholic hepatitis is the most likely diagnosis. Hemochromatosis would typically show more marked iron studies, and primary sclerosing cholangitis would more commonly present with bile duct abnormalities. Chronic hepatitis B would present with different serological markers.
**Specialty:** Gastroenterology