Biochemical Abnormalities In Pbc and Psc

Question 1

Primary Biliary Cholangitis (PBC)

Answer 1

Key Biochemical Abnormalities:

↑ Alkaline Phosphatase (ALP) – prominent cholestatic marker

↑ Gamma-glutamyl transferase (GGT)

↑ Cholesterol and HDL – often markedly elevated

↑ IgM (hyperglobulinemia)

Positive anti-mitochondrial antibodies (AMA) – in ~90–95% of cases.

Positive sp100 in 5%of cases

HLA-DRB1*08

↑ Bilirubin – in advanced disease

Mildly ↑ AST/ALT – less than in hepatitis

Question 2

Primary Sclerosing Cholangitis (PSC)

Answer 2

↑ ALP and GGT – cholestatic pattern

↑ Bilirubin – variable; may fluctuate early, persistent in advanced disease

↑ AST/ALT – mild to moderate elevation

↑ IgG4 – in a subset (IgG4-related PSC)

Positive p-ANCA – in ~60–80% (not specific)

↑ Cholesterol – may occur

↑ CA 19-9 – if cholangiocarcinoma develops