23rd July 2023

A 45-year-old is referred by her GP due to abnormal liver function tests

A 45-year-old is referred by her GP due to abnormal liver function tests.

On questioning, she reports a 6-month history of fatigue and, more recently, has noticed generalised itching. She drinks no more than 3 units of alcohol per week and does not smoke. She works as a gardener. Her only past medical history of note is Grave’s disease.

The only positive examination finding is of excoriation marks.

Her most recent blood tests are as follows:

• AST 44 u/L (1-45 u/L)
• ALT 32 u/L (<34 u/L)
• ALP 204 u/L (30-130 u/L)
• Bilirubin 18μmol (<21μmol)

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.