Gastroenterology
Case 38: A Jaundiced Woman with Profound Fatigue
CASE
A 42‐year‐old woman presents to the ward with a recent onset of jaundice. She has not been well for 4–6 weeks with profound fatigue and aching joints and muscles. Over the last week she has been noted by her family to have jaundice. She has lost three‐quarters of a stone in weight and has been off her food. She has no significant past medical history other hypothyroidism. She takes thyroxine 100 µg and the oral contraceptive pill. Her mother also had thyroid disease and diabetes. Her father has haemochromatosis.
On examination she looks tired and unwell. She is obviously jaundiced. She is haemodynamically stable and afebrile. She has bilateral palmar erythema and a few spider naevi on her upper chest. Abdominal examination is unremarkable.
Blood tests showed:
Hb 12.1 g/dL WCC 7.8 × 109/L Platelets 98 × 109/L PT 16 sec Na 32 mmol/L K 4.2 mmol/L Urea 2.8 mmol/L Creatinine 110 µmol/L Albumin 27 g/L Bilirubin 140 µmol/L ALP 115 U/L ALT 320 U/L Fe 12 µg/dL Ferritin 72 ng/mL HBsAg –ve HCV Ab –ve HAV IgM –ve IgG 30 g/dL IgA 3.4 g/dL IgM 2.4 g/dL TIBC 68 µg/dL
QUESTION 1
Your score this session: 0 of 0
The clinical presentation is most in keeping with a diagnosis of: