A 50-year-old female with known hepatitis C infection presents with new onset of pruritus and dark urine. Laboratory tests show elevated bilirubin levels and alkaline phosphatase. What could be the potential causes and next steps?
This patient's symptoms and lab findings could indicate a progression of her hepatitis C infection to cholestatic liver disease, or possibly the development of primary biliary cirrhosis, which can be associated with hepatitis C. Further diagnostic steps might include imaging studies such as an ultrasound to evaluate the biliary tree and possibly a liver biopsy to confirm the diagnosis and assess the extent of liver damage.