"deal or no deal" is on in the background while i'm writing this. quite possibly the most annoying show on tv. i haven't really watched it before and i'm happy about that now. it's not helping that there's a drama queen ("not that there's anything wrong with that") guy who's the contestant. really annoying. "take that deal, gary!"

more annoying or rather frustrating is a case i saw over the weekend: guy who came in with increasing bilirubin levels, now up to almost 17 mg/dL, mostly conjugated (direct). jaundiced like a mofo. alt's normal, ast ~3x upper limit of normal (odd, i know), normal alk phos. all scans normal except small amount of fluid around the liver and ? small ductal dilation. no fever but wbc count increasing significantly with bandemia. any ideas with this limited history??????? guy's a little demented at baseline, nursing home patient, so of course the family refused ercp.