Case Discussion 230916

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23 Sep 2016 - General

A middled age lady, originally from South America, with the background history of previous cholescystectomy, previous appendicectomy, hypertension, smoker, and social alcohol drinker, was referred from general practitioner (GP) due to few days history of jaundice, with general fatigue. Patient denied any other symptoms like nausea/vomiting, diarrhoea, abdominal pain, chest pain, shortness of breath, abdominal distension and fever. Patient also denied taking any illicit recreational drug. On further questioning, she did mentioned that Ivermectin for head lice a few days ago. Her liver function showed bilirubin around 170, with AST around 2100, ALT around 3890, INR 1.6, normal renal function, normal full blood count. What is your differential diagnosis ? What will be your investigations step?