A 59-year-old man develops fatigue and decreased appetite 3 months after receiving a mechanical aortic valve replacement

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A 59-year-old man develops fatigue and decreased appetite 3 months after receiving a mechanical aortic valve replacement His pulse is 88/min, respirations are 12imin, and blood pressure is 140/54 mm Hg. He appears tired. Physical examination shows mild scleral icterus. Jugular venous pressure is 8 cm H20 , and carotid upstrokes are normal. Lung fields are clear. Cardiac examination shows crisp prosthetic valve sounds and a grade 2/6, decrescendo diastolic murmur at the left sternal border. Abdominal examination shows no tenderness, normal liver size, and normal bowel sounds. Labratory studies of serum show a total billrubin concentration o 4mg/dL and a direct billrubin concentration of 1 mg/Dl. Which of the following is the most likely cause of the jaundice in this patient?


A) Cholelithiasis
B) Cholestasis
C) Hemolysis
D) Hepatocellulardisease
E) Passive congestion