Primary biliary cholangitis and primary sclerosing cholangitis Quiz: Ace Your Exams
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A 43-year-old woman comes to the clinic for a follow up. She has been experiencing occasional nausea. Past medical history is significant for ulcerative colitis for which she takes mesalamine. The last flare of ulcerative colitis was 2 years ago and was treated with a short course of intravenous steroids followed by an oral taper. She does not smoke or drink alcohol. Vitals are within normal limits. BMI is 37 kg/m2. Physical examination is unremarkable and there is no organomegaly. Labs are ordered and results are shown below. Right upper quadrant ultrasound is inconclusive due to body habitus. Which of the following is the next best step in management?
| Laboratory value | Result | Reference range |
| Serum Chemistry | ||
| Sodium | 142 mEq/L | 136-146 mEq/L |
| Potassium | 4.2 mEq/L | 3.5-5 mEq/L |
| Chloride | 95 mEq/L | 95-105 mEq/L |
| Creatinine | 1.2 mg/dL | 0.6-1.2 mg/dL |
| Liver Function Test | ||
| Total bilirubin | 1.4 mg/dL | 0.1-1 mg/dL |
| Direct bilirubin | 0.8 | 0-0.3 |
| Alkaline phosphatase | 310 U/L | 20-70 U/L |
| Alanine aminotransferase (ALT) | 25 U/L | 8-40 U/L |
| Aspartate aminotransferase (AST) | 21 U/L | 8-40 U/L |
| Gamma-glutamyl transferase | 120 U/L | 0-30 U/L |
| Albumin | 4 g/dL | 3.5-5.5 g/dL |
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