Primary biliary cirrhosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2], Mehrian Jafarizade, M.D [3]

Overview

Primart biliary cirrhosis must be differentiated from other disease that may cause cholestasis.^[1]^[2]^[3]^[4]^[5]

Disease	History and clinical manifestations				Diagnosis
	History and clinical manifestations				Lab Findings						Other blood tests	Other diagnostic
	Family history	Fever	RUQ Pain	Pruritis	AST	ALT	ALP	BLR Indirect	BLR Direct	Viral serology	Other blood tests	Other diagnostic
Autoimmune hepatitis	-/+	-	-	-/+	↑	↑	N	↑/N	N	-	Anti-LKM antibody	Liver biopsy
Common bile duct stone	-/+	-	+	+	N	N	↑	N	↑	-	Dilated ducts on ultrasound	CT/ERCP
Hepatitis A (cholestatic type)	-	-/+	+	+	N/↑	N/↑	↑	N	↑	+	HAV- Ab	Abdominal ultrasound
EBV / CMV hepatitis	-	-/+	+	+	N	N	↑	N	↑	+	Positive serology	-
Primary biliary cirrhosis	-/+	-	-/+	+	N/↑	N/↑	↑	N	↑	-	AMA positive	Liver biopsy
Primary sclerosing cholangitis	-/+	-	-/+	+	N/↑	N/↑	↑	N	↑	-	↑Autoantibodies (P-ANCA), hypergammaglobulinemia	MRCP, Liver biopsy
Pancreatic carcinoma	+	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	-	CT scan for diagnosis
AIDS cholangiopathy	-	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	HIV Ab	Ultrasound or ERCP
Parasites induces cholestasis	-	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	Serology	Ultrasound or ERCP
Intrahepatic cholestasis of pregnancy	-/+	-	-/+	+	↑	↑	↑	N	↑	-	Thrombocytopenia	Diagnosed clinically

↑ Fargo MV, Grogan SP, Saguil A (2017). "Evaluation of Jaundice in Adults". Am Fam Physician. 95 (3): 164–168. PMID 28145671.
↑ Leevy CB, Koneru B, Klein KM (1997). "Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease". Gastroenterology. 113 (3): 966–72. PMID 9287990.
↑ Hov JR, Boberg KM, Karlsen TH (2008). "Autoantibodies in primary sclerosing cholangitis". World J. Gastroenterol. 14 (24): 3781–91. PMC 2721433. PMID 18609700.
↑ Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ (1987). "Gall stones in sickle cell disease in the United Kingdom". Br Med J (Clin Res Ed). 295 (6592): 234–6. PMC 1247079. PMID 3115390.
↑ Malakouti M, Kataria A, Ali SK, Schenker S (2017). "Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do?". J Clin Transl Hepatol. 5 (4): 394–403. doi:10.14218/JCTH.2017.00027. PMC 5719197. PMID 29226106.