1. Case 34

2. History
51 Y AAM c/o intractable itching, jaundice and 60 lb wt loss > 8 months
Took over the counter medication
Liver biopsy
Treated with urso-deoxycholic acid
Hiccups
Pruritus
>8 months
15 days
30 days
chlorpromazine
Persistent pruritus
>60 lbs wt loss

3. History Lab values were Liver biopsy Treatment: Urso-deoxycholic acid
Alkphos-750’s,
amino-transferases <100’s,
TB-30.0/DB-12.0
Liver biopsy
cholestasis with ductopenia,
mild sinusoidal fibrosis,
mild increase in iron deposition
Treatment: Urso-deoxycholic acid

4. History PMH: Positive for PPD treated in 1980 (meds-unknown)
Social History: Worked at Sanitation dept X 25 yrs, No alcohol for 20 yrs ago

5. Physical Examination Malnourished, Cachetic
BMI (Wt-118 lbs, Ht-5’8”)
Jaundiced, temporal muscle wasting
Otherwise insignificant examination

6. Laboratory Data Alka Phos: 1100 AST: 80 ALT: 79 TB: 32.6 DB: 30.0
Tot Prot: 6.6
Alb: 2.2
Plt: 697
H/H: 9.0/27.3
Bun: 33
Cr: 1.8
PT-10.6 / INR- 1.0
Hepatitis serology: negative
AMA: Neg
ANA: Neg
IgG: 1150 (nl)
IgM: 223 (nl)
AFP: 4.6
Ca 19-9: 41.3 ( IU/ml
TSH: 2.19

7. Peritoneoscopy

8. -MARKED ABSENCE OF BILE DUCTS
-CHOLESTASIS
RARE ESINOPHILS
MARKED PORTAL FIBROSIS
IRON OVER LOAD IN THE KUFFER CELLS

9. Management
Patient was actively listed for Liver Transplant for intractable pruritus
Treated with plasmapheresis for pruritus
Urso-dexoycholic acid

10. Follow up Patient regained 25 lbs Persistent Pruritus Weight MELD
Bilirubin
Albumin
INR