The following data refer to a 34-year-old male admitted to ICU twenty days after an allogeneic stem cell transplant for acute myeloid leukaemia. Over the last few days he has been complaining of right upper quadrant abdominal pain, and observed to have gained several kilograms in weight.

Venous Biochemistry

Parameter

Patient Value

Adult Normal Range

Sodium

142 mmol/L

135 – 145

Potassium

4.8 mmol/L*

3.5 – 4.5

Chloride

97 mmol/L

95 – 105

Bicarbonate

22 mmol/L

22 – 26

Urea

11.2 mmol/L*

2.9 – 8.2

Creatinine

134 μmol/L*

70 – 120

Calcium

2.13 mmol/L

2.10 – 2.55

Phosphate

1.21 mmol/L

0.65 – 1.45

Total bilirubin

342 μmol/L*

0 – 25

Aspartate aminotransferase (AST)

175 U/L*

< 40

Gamma glutamyl transferase (GGT)

123 U/L*

< 40

Alanine aminotransferase (ALT)

87 U/L*

< 40

  1. Give the most likely diagnosis. (10% marks)
  1. What are the characteristic findings on liver ultrasound scan? (10% marks)

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College answer

a) Veno-occlusive disease of the liver (sinusoidal obstruction syndrome)

b) ascites and reversal of portal vein flow. (2 marks)