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Oct 29, 2010
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please I need a diagnosis for this case

A 49-year man presented to clinic complaining of vague diffuse abdominal pain over the last month . the pain constant dull ache, accompanied by nausea and abdominal distention, aggravated after eating. He denied radiation to the back or shoulder, vomiting, hematemesis, fever. Although the patient had lost 5 Kg in the last 3 months; he denied any change in appetite.
He had a history of intravenous drug abuse, numerous tattoos, and had multiple sexual partners. He had never received any blood product transfusions.
On physical examination the patient was afebrile. On inspection he had no gynecomastia, spider angiomata, palmar erythema, caput medusa, or rash. Mildly icteric sclerae were noted. There was no neck, axillary, or inguinal lymphadenopathy.
His abdomen was soft and non-distended with diffuse tenderness on deep palpation most prominent in the right upper quadrant. Marked hepatomegaly was noted but there was no splenomegaly or ascites. The patient’s extremities were warm, without edema.
Albumin 2.3 g/dL
Total Protein 8.0 g/dL
Bilirubin 2.5 mg/dL
Alkaline Phosphatase 185 IU/L
GGT 810 IU/L
SGOT (AST) 220 IU/L
SGPT (ALT) 76 IU/L
AFP (Alpha Fetoprotein) >1200 ng/mL

what is the primary diagnosis?

can hepatocellular carcinoma be the final diagnosis even there is no stigmata of chronic liver disease & the symptom started within a month???????
 
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