A 38-year-old man comes to the physician for a 1-day history of abdominal pain, fever, and chills. He was hospitalized one year ago for a similar episode. Ultrasound and CT of the abdomen show no abnormalities. He is commenced on IV fluids and antibiotics. He has history of ulcerative colitis managed with sulfasalazine. Temperature is 38 C, HR 90, RR 16, BP 130/90. Physical examination shows jaundice and epigastric tenderness without rebound or masses. Laboratory studies show:
Total bilirubin 2.8 mg/dL
Alkaline phosphatase 350 U/L
Which of the following is the most likely diagnosis?
Acute cholecystitis
Acute pancreatitis
Budd-Chiari syndrome
Primary biliary cirrhosis
Primary sclerosing cholangitis
