And then kind of that will then help you, you know, in addition to the symptoms that, you know, Alison talked about, but what do we do next in that workup? And what does that look like?

Yeah, and then I think once we kind of, like you said, fractionate it, and I've seen even just recently, even some patients with chronic kidney disease or patients who are on dialysis, you know, if patients have a decreased creatinine clearance, they also can have these transiently elevated alkaline phosphatases, which can kind of make you think that there's something liver going on when really it's, you know, because of a decreased clearance.

And so I think for me, once I get a good history and once we confirm that it's a cholestatic pattern with an elevated ALK-FOS and a GGT, I think the next thing for me is imaging.

At that point, I kind of want to make sure, are the bile ducts dilated? Does it look like we have a stricture? Are we looking at something like PSC? which is where we have a narrowing in the bile ducts that's causing the stasis problem, or is it an actual liver parenchymal problem, or is there a normal bile duct, but the flow of bile is the problem, which would be more things like, you know, PVC.

So I think after the initial history and getting a good detailed events leading up to when the symptoms started and then doing the labs, for me, the imaging would be the next best thing.

And I think that depending on the severity of the symptoms is how I would determine what would be my next step for imaging.

I think that we all want to try to do things like ultrasounds because it's easy and non-invasive and usually approved by the insurance.

So when we are looking at, you know, so Allison, what do you do when the ultrasound shows that there is something going on with the bottlenecks? Then what will you do?