A Patient with Primary Sclerosing Cholangitis and Diffuse Biliary Dilation

Question: A 61-year-old man with a history of primary sclerosing cholangitis (PSC) was referred for evaluation of progressive jaundice, abdominal distension, and lower extremity edema over the last several months. Vital signs were within normal ranges. Physical examination revealed a thin, jaundiced man with scleral icterus, a nontender distended abdomen with positive shifting dullness, caput medusae, and pitting lower extremity edema....