<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 19-year-old woman undergoes an laparoscopic appendectomy for acute appendicitis. During the procedure, a black, discolored liver is noted. Other than the recent appendicitis, the patient has no history of serious illness and takes no medications. She has no medication allergies. She does not drink alcohol or use illicit drugs. She has an uncomplicated postoperative course. At her follow-up visit 3 weeks later, her vital signs are within normal limits. Examination shows scleral icterus, which the patient states has been present for many years. Abdominal examination shows healing scars without drainage or erythema. Serum studies show:Aspartate aminotransferase 30 IULAlanine aminotransferase 35 IULAlkaline phosphatase 47 mgdLTotal bilirubin 5.2 mgdLDirect bilirubin 4.0 mgdLWhich of the following is the most likely diagnosis?? A: Type II Crigler-Najjar syndrome, B: Dubin-Johnson syndrome, C: Gilbert syndrome, D: Rotor syndrome, E: Wilson disease,  <response>: Based on the information provided in the question stem, the key findings are:- 19-year-old woman - Black, discolored liver noted during laparoscopic appendectomy- No history of serious illness, takes no medications- No alcohol or illicit drug use- Scleral icterus present for many years - Mildly elevated total and direct bilirubin- Normal AST, ALT, and alkaline phosphataseThe chronic scleral icterus along with mildly elevated direct bilirubin and normal liver enzymes point towards a diagnosis of Dubin-Johnson syndrome. Type II Crigler-Najjar syndrome can be ruled out since it would cause much higher levels of bilirubin. Gilbert syndrome and Rotor syndrome would not cause direct hyperbilirubinemia. Wilson disease would be associated with elevated AST and ALT.Therefore, based on the clinical findings, the most likely diagnosis is Dubin-Johnson syndrome.B: Dubin-Johnson syndrome 