A 66-year old female presents to the primary care office wit…
A 66-year old female presents to the primary care office with CC: “my eyes are yellow.” The patient has noticed her skin is very itchy, she is feeling more tired, and generally does not feel well. She is having some back pain and notes her urine looks dark. A urine dip in the clinic reveals a high level of bilirubin. The NP knows the bilirubinuria is a sign of