<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 32-year-old man comes to the physician for a follow-up examination. He has a 2-month history of increasing generalized fatigue and severe pruritus. He has hypertension and ulcerative colitis which was diagnosed via colonoscopy 5 years ago. Current medications include lisinopril and rectal mesalamine. He is sexually active with 2 female partners and uses condoms inconsistently. His temperature is 37.3C 99.1F, pulse is 86min, and blood pressure is 13084 mm Hg. Examination shows scleral icterus and multiple scratch marks on the trunk and extremities. The lungs are clear to auscultation. The abdomen is soft and nontender. The remainder of the examination shows no abnormalities. Laboratory studies show:Hemoglobin 11.5 gdLLeukocyte count 7500mm3Platelet count 280,000mm3SerumNa 138 mEqLCl- 101 mEqLK 4.7 mEqLUrea nitrogen 18 mgdLGlucose 91 mgdLCreatinine 0.8 mgdLBilirubinTotal 1.5 mgdLDirect 0.9 mgdLAlkaline phosphatase 460 ULAST 75 ULALT 78 ULAnti-nuclear antibody negativeAntimitochondrial antibodies negativeAbdominal ultrasound shows thickening of the bile ducts and focal bile duct dilatation. Which of the following is the most likely diagnosis?? A: Autoimmune hepatitis, B: Primary sclerosing cholangitis, C: Primary biliary cholangitis, D: Hepatitis B infection, E: IgG4-associated cholangitis,  <response>: Based on the information provided in the question stem, the key findings are:- 32-year-old man with 2-month history of fatigue and severe itching - Has hypertension and ulcerative colitis- Physical exam shows jaundice and scratch marks- Lab studies show elevated liver enzymes ALT, AST, alkaline phosphatase, elevated bilirubin, normal kidney function- Negative ANA and anti-mitochondrial antibodies- Ultrasound shows bile duct thickening and dilatationThis presentation is most consistent with cholestatic liver disease. The negative autoantibodies make autoimmune hepatitis less likely. The ultrasound findings of bile duct abnormalities point towards a diagnosis involving the biliary system. Of the choices given, primary sclerosing cholangitis and primary biliary cholangitis are the most likely based on the clinical presentation. Between these two, primary sclerosing cholangitis is more likely given the patients history of ulcerative colitis and the ultrasound findings of bile duct thickening and dilatation.B: Primary sclerosing cholangitis 