Approach to jaundice (conjugated hyperbilirubinemia) Quiz: Ace Your Exams
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A 42-year-old woman is brought to the emergency department for evaluation of 3 days of yellowing skin, lethargy, anorexia, nausea, and vomiting. Medical history is significant for insulin-dependent type 1 diabetes. She is not on any other medications. Vitals are within normal limits. The patient appears lethargic but is alert and oriented. She has evidence of jaundice and scleral icterus without signs of cirrhosis. Abdominal exam is significant for right upper quadrant pain. Initial laboratory evaluation is shown below. Which of the following tests should be ordered next?
| Laboratory value | Result | Reference Range |
| Alkaline Phosphatase (ALP) | 205 U/L | 20-70 U/L |
| Alanine aminotransferase (ALT) | 1134 U/L | 8-40 U/L |
| Aspartate aminotransferase (AST) | 1231 U/L | 8-40 U/L |
| Total bilirubin | 24 mg/dL | 0.1-1.0 mg/dL |
| INR | 3.0 | 0.8-1.1 |
| Serum iron | 100 mcg/dL | 50-170 mcg/dL |
| Serum transferrin | 250 mg/dL | 200-360 mg/dL |
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