The LFTs shown are consistent with the picture of primary sclerosing cholangitis. However, the clinical picture of acute onset epigastric pain and nausea and vomiting is not a common finding in PSC.

According to the 2012 Revised Atlanta Classification, the diagnosis acute pancreatitis requires at least two of the three following criteria: (1) abdominal pain consistent with pancreatitis, (2) serum amylase and/or lipase of at least three times the upper limit of the normal value or (3) findings consistent with acute pancreatitis on imaging (contrast-enhanced CT (CECT), MRI or ultrasound).

In Sally’s case, it is in fact essential to rule out pancreatitis. Sally’s amylase was markedly raised leading to a suspicion of acute pancreatitis.

The LFTs show an obstructive jaundice image, which alongside acute pancreatitis points to the presence of gallstones. This suspicion could be confirmed with CT abdomen and ultrasound.