Question: A 45-year-old man presented with intermittent abdominal pain, dark urine, and constipation for 6 months. Laboratory tests of the initial episode showed total bilirubin 109.9 μmol/L (reference range, 3.4-20.5), alanine aminotransferase 3500 U/L (reference range, 9-40), aspartate aminotransferase 1860 U/L (reference range, 15-40), gamma-glutamyl transferase 763 U/L (reference range, 10-60), and alkaline phosphatase 164 U/L (reference range, 45-125). The patient was discharged with abnormal liver biochemistry.