Conversation: The conversation between human and AI assistant.
[|Human|] my husband has a very large gastrinoma that has spread to the liver... he is most bothered by severe itching that keeps him from sleeping despite numerous forms of narcotics.. antidepressants ( seroquel , mirtazapine are of no benefit) he has tried various types of benedryl , atarax with no use. Just wondering if you have any other suggestions for the severe itchiness. I was reading that hyperparathyroidism is also associated with his condition and if increasing his vitamin D would be of any benefit pertaining to the itching. by the way his serum bile is not elevated - any help would be appreciated
[|AI|]  Hello! Thank you for the query. His severe itching is caused by jaundice. Due to bile ducts obstruction or liver failure bilirubin accumulates in the body including skin. This causes yellow skin (not always visible), itching, dark urine, stools can be white. He should visit his doctor, have abdominal ultrasound, blood work, bilirubin level, liver tests (AST, ALT,AP, GGTP) and amylase. In case of elevated liver tests, ERCP and stent to bile ducts should be placed. Hope this will help. Regards.