Patient With Mild Hepatomegaly and Skin Excoriations

A 55-year-old woman is evaluated for a 4-month history of progressive fatigue and pruritus. She is otherwise healthy and takes no medications. Physical examination :  Her vital signs are normal; BMI is 25. Examination reveals mild hepatomegaly and excoriations of the skin. There is no jaundice, rash, or skin eruption.

Laboratory studies: Bilirubin (total): 1.5 mg/dL (25.6 µmol/L) Aspartate aminotransferase: 60 U/L Alanine aminotransferase: 75 U/L Alkaline phosphatase: 470 U/L Albumin: 4.0 g/dL  Hepatitis C virus antibody: Negative Hepatitis B surface antigen: Negative Ultrasonography of the abdomen is normal with no bile duct dilatation. What should be the next step in the diagnosis of this patient? * This patient case is from the Docplexus Editorial Team for educative purposes only.