<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 57-year-old man is brought to the emergency department because of a 2-day history of fever and right upper quadrant abdominal pain. Examination shows jaundice. Ultrasonography of the abdomen shows cholelithiasis and marked dilation of the biliary duct. An ERCP is performed and reveals pus with multiple brown concrements draining from the common bile duct. Which of the following is the most likely underlying cause of the patients findings?? A: Increased alanine aminotransferase activity, B: Decreased heme oxygenase activity, C: Decreased HMG-coenzyme A reductase activity, D: Increased cholesterol 7-α hydroxylase activity, E: Increased β-glucuronidase activity,  <response>: This is a clinical case question asking about the most likely underlying cause of a 57-year-old mans fever, right upper quadrant abdominal pain, jaundice, cholelithiasis, dilated biliary ducts, and purulent drainage with brown concrements from the common bile duct seen on ERCP. The key findings are:- Fever and RUQ pain - suggests biliary infectioninflammation- Jaundice - suggests biliary obstruction- Cholelithiasis - gallstones- Dilated biliary ducts - suggests obstruction- Purulent drainage and brown concrements from CBD on ERCP - indicates infected bile duct stonesThis clinical picture is most consistent with cholangitis due to infected bile duct stones. The underlying cause would be increased β-glucuronidase activity, which leads to precipitation of bilirubin diglucuronide into pigmented stones.The other choices do not explain the patients presentation. Increased ALT can be seen with biliary obstruction but does not explain stone formation. Decreased heme oxygenase, HMG-CoA reductase, and cholesterol 7-α hydroxylase activity are not associated with pigmented stone formation.E: Increased β-glucuronidase activity 