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A 45 year old woman presents with jaundice and pruritus for 2 weeks. She is otherwise asymptomatic.

She had a similar episode 1 year ago, which lasted for a few weeks and resolved spontaneously. She did not seek medical advice, and was symptom free afterwards.

She is not on any medications, only drinks socially, and denies promiscuity or drug abuse.

A full blood count is within normal parameters. An ultrasound scan of the abdomen reveals mild hepatomegaly only, with no evidence of gallstones.

Select Relevant Investigations
Liver Function Tests

Performed

AST: 90 U/L (<35)
ALT: 123 U/L (<35)
ALP: 972 U/L (40-125)
GGT: 796 U/L (5-55)
Total Serum Bilirubin: 6.1 mg/dL (<1)
Direct Bilirubin: 4.2 mg/dl (0.1-0.4)
INR: 2 (0.9-1.1)
Albumin: 3.4 g/dL (3.4-5.4)
MRCP & MRI Abdomen

Performed

Mild hepatomegaly is present. The anatomy of the biliary tract is within normal parameters, with no evidence of obstruction or narrowing.
ANA, SMA, AMA antibodies

Performed

Antinuclear Antibodies (ANA): negative
Smooth Muscle Antibodies (SMA): negative
Antimitochondrial Antibody (AMA): positive
Hepatitis Virus Panel

Performed

HBsAg: Negative
Anti-HBs: Negative
HBeAg: Negative
Anti-HBe: Negative
Anti-HBc: Negative
HBV DNA: Negative
HCV RNA: Negative
Anti HDV total: Negative

Select Relevant Management
Ursodeoxycholic Acid
Corticosteroids
Cholestyramine
Liver Transplantation