36 year old Thai man jaundiced with abdominal distension, what is likely cause?
Fisherman (freshwater) in the north-east of Thailnd. Wife and many children, monogamous, HIV negative. Lives in jungle area, near river, many dogs, chickens, monkeys, goats, cows, pigs. Toilet is outside. No fever, very thin.
Eats a normal Thai diet - Som Tam, Koi Pla, lots of rice. Does not feel ill - came in to clinic because he is getting yellowing of skin and whites of eyes - jaundiced. Previously healthy, no prior med prob or surgery. No diseases running in family.
Distension going on for months. Getting bigger. Exam: jaundiced, has large palpable non-tender mass below liver on his right side. No enlarged liver or spleen
Obviously has liver problem but what are possible causes?