Evaluating Liver Test Abnormalities
Understanding the Pathophysiology of Liver Disease
for Health Care Providers
Primary Biliary Cirrhosis (PBC)
Introduction
Primary biliary cirrhosis (PBC) is an autoimmune disorder that occurs mainly in middle-aged females. Bile duct injury is secondary to granulomatous destruction of intrahepatic bile ducts.
History
Patients may be entirely asymptomatic. The most common presenting symptoms are fatigue and pruritus. In patients with advanced disease there may be symptoms of deficiency of fat-soluble vitamins (e.g. easy bruising, night blindness, metabolic bone disease). As PBC is frequently associated with Sjogren's syndrome and Raynaud's phenomenon, the presence of dry eyes or skin changes with cold weather should be investigated.
Physical examination
The followings may be present:
- Xanthomata, xanthelasma
- Hyperpigmentation
- Excoriation marks (from scratching)
- Stigmata of chronic liver disease (particularly if cirrhosis is present)
- Jaundice
Investigation
- Anti-mitochondrial antibodies (AMA)
- Albumin*
- PT/INR*
- Platelet level*
*In patients with any chronic liver injury, the presence of thrombocytopenia, coagulopathy or hypoalbuinemia is suggestive of cirrhosis.