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.
respiratory examination was unremarkable. Abdominal examination revealed
hepatosplenomegaly but no ascites.
Urine was positive
Hb 10.0 g/dL
WBC 3.5 x109/L
Platelets 120 x109/L
Bilirubin 63 umol/L
Alkaline phosphatase 34IU/L
In this patient which one of the
following test would you arrange?