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Primary Biliary Cholangitis — RACP Adult Medicine MCQ

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ModerateGastroenterologyPrimary Biliary CholangitisRACP Adult Medicine

A 50-year-old woman presents with pruritus and fatigue. ALP is 450 U/L, GGT 380 U/L (confirming hepatic origin). ALT is 55 U/L. Anti-mitochondrial antibody (AMA) is positive (1:640). IgM is elevated. Liver biopsy shows florid duct lesion (granulomatous destruction of bile ducts). What is the most likely diagnosis?

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Correct answer: B — Primary biliary cholangitis

Raised ALP (hepatic origin confirmed by elevated GGT) with pruritus, positive AMA (>95% specific), elevated IgM, and florid duct lesion on biopsy is primary biliary cholangitis. Treatment: UDCA (13-15 mg/kg/day) — improves biochemistry and slows progression. Obeticholic acid (FXR agonist) is second-line for inadequate UDCA response. Monitor with ALP response at 12 months (Paris-II or Toronto criteria).

Reference: EASL – 2022 – PBC Guidelines; eTG Gastrointestinal 2024