Trilogy of chronic liver disease needs to be evaluated There is a small lesion in liver which needs further investigation

Based on the history and reports, this appears more consistent with chronic liver disease (CLD) with portal hypertension, associated gallstone disease (calculous cholecystitis), and recurrent episodes of obstructive jaundice/cholangitis. The MRCP does not show dilatation of the bile ducts or a CBD stone at present, so the jaundice may not be due to persistent biliary obstruction alone. Diabetes-related metabolic liver disease (MASLD/NASH), previous infections, viral hepatitis, autoimmune liver disease, or other chronic liver disorders should also be evaluated as possible underlying causes. Gallbladder removal should not be decided solely on the basis of gallstones. Because there is evidence of portal hypertension, splenomegaly, and collateral vessels, cholecystectomy carries a higher surgical risk and should be planned only after evaluation by a hepatologist and an experienced hepatobiliary surgeon.

Hello Madam, Your father’s recurrent fever and jaundice require urgent evaluation. Although he has a history of a 7 mm gallstone, the MRCP does not show any bile duct stone or biliary obstruction. Instead, it shows multiple gallstones with acute calculous cholecystitis, along with chronic liver disease, portal hypertension (splenomegaly and collateral vessels), and a nodular liver. His LFTs show persistent direct hyperbilirubinemia (Total bilirubin 3.71 mg/dL, Direct 2.06 mg/dL) with elevated ALP, indicating ongoing liver/biliary disease. The chronic liver disease is unlikely to be caused by gallstones alone. Given his 30-year history of diabetes, MASLD (fatty liver disease) is a likely cause, although viral, autoimmune, and other liver diseases must be excluded.