A very interesting case of primary biliary cholangitis (PBC) was presented. The patient presented with painless jaundice found to have an obstructive picture of LFT’s. When thinking about obstructive LFT’s without ductal dilation you can separate into two categories, if the Alk Phos is moderately elevated consider hepatitis and cirrhosis, if the alk phos is very elevated as in our patient consider medications, sepsis and PBC.
PBC seen most often in 40-60 y/o women, (87% of all cases are in women). It is associated with other autoimmune disorders and has a positive AMA. Patient’s present with cholestasis, elevated AMA and destruction of the interlobular ducts on liver biopsy. Patient’s will also have significant hyperlipidemia.