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23rd April 2024
A 42-year-old female presents with worsening jaundice and itch. This has been gradually getting worse
A 42-year-old female presents with worsening jaundice and itch. This has been gradually getting worse over the past 6 weeks. She does not report any abdominal pain and denies any fevers or rigors. She has a past medical history of Primary Biliary Cirrhosis (PBC) and Sjogren’s. She takes ursodeoxycholic acid for PBC and chlorphenamine for itch. When asked about recent travel, she has not been anywhere recently herself, however, her husband had recently returned from India and had been unwell with a “tummy bug” for a few weeks. He has since recovered from this. On examination, she is visibly jaundiced. Her liver was palpable 3 cm below the costal margin with a palpable nodule. Her abdomen is soft and non-tender.
Investigations show the following:
| Haemoglobin | 115/l |
| White Cell Count | 10.5*10⁹/l |
| Neutrophils | 8.0*10⁹/l |
| Platelets | 340*10⁹/l |
| Sodium | 136 mmol/l |
| Potassium | 3.9 mmol/l |
| Urea | 4.1 mmol/l |
| Creatinine | 65 µmol/l |
| Bilirubin | 80 µmol/l |
| Alkaline Phosphatase | 190 u/l |
| ALT | 100 u/l |
| Gamma-GT | 90 u/l |
| Albumin | 27 g/l |
What is the most likely cause?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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