Cholestatic liver disease Quiz: Ace Your Exams

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A 4-week-old female is brought to the pediatrician for evaluation of jaundice which began 3 weeks ago. In addition, according to the mother, the patient’s urine has become progressively darker and is “yellowish-brown” in color. The patient was born at 40 weeks gestation via an uncomplicated vaginal delivery. Her blood is type A, Rh-negative. The mother’s blood is type AB, Rh-positive. The patient is exclusively breastfed and products between 6-7 wet diapers daily. Physical examination shows scleral icterus, as well as jaundice of the head and neck. Abdominal exam is notable for a firm and enlarged liver. The remainder of the physical examination is noncontributory. Laboratory testing reveals the following findings:
 
 Laboratory value  Result 
 Total bilirubin  7.2 mg/dL 
 Conjugated bilirubin  6.5 mg/dL 
 Alkaline phosphatase  115 U/L 
Which of the following best describes the most likely cause of this patient’s finding?

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