A middle-aged woman with jaundice, severe pruritus, hepatomegaly and a cholestatic picture (ALP high, mostly direct bilirubin, only mild AST/ALT rise) fits primary biliary cirrhosis/cholangitis - an autoimmune disease of females affecting the intrahepatic ducts; bile-acid backflow causes the itch.

• Sclerosing cholangitis is the tempting option but is typically a male with ulcerative colitis.
• Chronic hepatitis C would give a hepatocellular pattern; Wilson's is a young patient's disease.