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 BOF 17

 

   

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BOF: 17

A 50-year-old male presents with a history of recurrent episodes of fever of 8 months duration.

He also complains of discomfort in his right upper abdomen. He gives a history of jaundice and passage of pale stools in conjunction with the fever.

For the last 2 months he has been having itching of his skin

He gives a history of having periods where he passes dark urine.

He has had a cholecystectomy in the past for gallstones.

On examination he was febrile, pale and icteric.

He was noted to have white nails, palmar erythema and spider naevi. There were widespread excoriations of his skin.

Cardiovascular and respiratory examination was unremarkable. Abdominal examination revealed hepatosplenomegaly but no ascites.

Urine was positive for bile

Investigations

Hb 10.0 g/dL

MCV 105

WBC 3.5 x109/L

Platelets 120 x109/L

Bilirubin 63 umol/L

Alkaline phosphatase 34IU/L

Albumin 25g/L

In this patient which one of the following test would you arrange?

a)      Liver biopsy

b)      ERCP

c)      Blood cultures

d)      ANCA

e)      Reticulocyte count

 

 

 

 

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