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A 41-year-old woman presents to her primary care physician reporting fatigue for the past 3 months. On further questioning, she notes dry eyes and dry mouth, as well as whole-body itching for the past 3 months. She denies any change in skin color. For the past year, she has had a persistently elevated alkaline phosphatase around 300 IU/L (normal 40 to 120 IU/L) as well as elevated total bilirubin at 2.4 (normal 0.3 to 1.9 mg/dL) and direct bilirubin at 0.7 (normal 0 to 0.3 mg/dL). Her aminotransferase levels have been within normal limits and RUQ ultrasound was unremarkable. Further testing revealed a positive anti-mitochondrial antibody titer, and a liver biopsy was performed (Figure A). Which of the following is the most appropriate treatment for this patient at this time?
Endoscopic balloon dilation
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A 65-year-old female with a history of rheumatoid arthritis presents to her primary care physician because she is concerned about her skin. She states that over the past few months she has become extremely itchy, in spite of applying numerous creams and lotions. She states that she has not noticed any visible changes or rashes on her skin and feels well apart from mild fatigue. On exam, the physician appreciates hepatosplenomegaly and observes the findings shown in Figure A. Laboratory testing reveals elevated antimitochondrial antibodies and a liver biopsy is obtained which is demonstrated in Figure B. What is the most likely underlying pathophysiology of this patient's disease?
Interlobular bile duct destruction
Intra and extrahepatic bile duct fibrosis
Extrahepatic bile duct obstruction
Absent UDP-glucuronyl transferase
Decreased bilirubin uptake
A 36-year-old female with a history of celiac disease presents to her primary care physician because of recent changes to her health. She states that over the past several months she has noticed her eyes and skin seem to have become more yellow in color and she has also noticed increased itchiness all over her body. On exam, the patients eyes are shown to be as demonstrated in Figure A and an additional finding is observed around her eyes as demonstrated in Figure B. The physician obtains liver function tests which demonstrate an increased direct bilirubin and an increased alkaline phosphatase. Further testing demonstrates increased serum mitochondrial antibodies and a liver biopsy is obtained as demonstrated in Figure C. What is the first-line treatment for this patient's condition?