A 58-year-old woman presents to your office complaining of generalized itching. On examination, she appears to have jaundice. She mentions that she has experienced a 4.5-kg weight loss over the past several months and recently has noted the passage of tea-colored urine. Medical history Her past medical history is significant for type 2 diabetes mellitus that was diagnosed five months previously, and she denies any history of hepatitis. Examination Her temperature and the remainder of her vital signs are within normal limits.
The abdomen is soft and nontender. The gallbladder is palpable but without tenderness. Her stool is Hemoccult negative. The laboratory evaluation reveals a normal complete blood count. Other laboratory findings are: total bilirubin 12.5 mg/dL, direct bilirubin 10.8 mg/dL, aspartate aminotransferase (AST) 120 U/L, alanine aminotransferase (ALT) 109 U/L, alkaline…
