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⚕️ FREE MSRA PODCAST – Primary Biliary Cholangitis (PBC): Diagnosis, Features & Management
🎧 High-yield breakdown of PBC – an autoimmune liver condition often tested in MSRA. We simplify the pathophysiology, investigations, and NICE-based management.
🧠 Key Learning Points
📌 Definition
• Chronic autoimmune liver disease
• Affects small intrahepatic bile ducts → progressive cholestasis
• Formerly “Primary Biliary Cirrhosis”
• Can lead to cirrhosis and liver failure
📌 Causes & Risk Factors
• Autoimmune origin – trigger unclear
• Genetics + environment likely involved
• Antimitochondrial antibodies (AMA) in 90–98%
• Female (9:1), age 40–60, family history
🧠 Mnemonic: GET TAP BC – Genes → Environment → Trigger → Autoimmune → Bile ducts → Cirrhosis
📌 Pathophysiology
• Immune destruction of bile ducts → cholestasis → fibrosis
• Bile backup damages liver cells → cirrhosis over time
📌 Symptoms
• Fatigue (common), pruritus (early), jaundice (late)
• RUQ discomfort, hepatomegaly
• Xanthelasma, hyperpigmentation
• Many are asymptomatic at diagnosis (raised LFTs)
📌 Associated Conditions
• Sjögren’s, autoimmune thyroiditis, Raynaud’s
🧠 Mnemonic: FJHIPJAX – Fatigue, Jaundice, Hepatomegaly, Itching, Pain, Jaundice (again), Ascites, Xanthelasma
📌 Differentials
• PSC, autoimmune hepatitis, drug-induced injury, viral hepatitis, sarcoidosis, biliary obstruction
📌 Diagnosis
✅ Bloods:
– AMA (+ in most)
– ↑ IgM
– ± ANA/ASMA
✅ LFTs – Cholestatic pattern:
– ↑ ALP, ↑ GGT, ↑ Bilirubin (late)
✅ Imaging:
– Ultrasound to exclude obstruction
– MRCP to rule out PSC
✅ Liver biopsy – if diagnosis unclear or overlap suspected
📌 Management
1. Medical:
• Ursodeoxycholic acid (UDCA) – first-line
• Obeticholic acid – second-line
2. Symptom Control:
• Itching: cholestyramine, antihistamines, rifampicin
• Fatigue: difficult to treat; modafinil (off-label)
3. Nutrition:
• Monitor fat-soluble vitamins (A, D, E, K)
• Bone protection for osteoporosis
4. Liver Transplant:
• If decompensation, bilirubin 100 µmol/L, MELD 15, or intractable pruritus
📌 Prognosis
• Early UDCA = excellent outcome
• ~40% are non-responders → worse outlook
• Transplant improves survival; fatigue may persist
• 20% recurrence post-transplant
📌 Complications
• Cirrhosis, liver failure, portal hypertension
• Varices, ascites, osteoporosis
• HCC (esp. in men or cirrhosis), renal tubular acidosis
• Hypothyroidism (20%), fat-soluble vitamin deficiency
📎More MSRA Resourcesfor Primary Biliary Cholangitis
📝 Revision Notes:
https://www.passthemsra.com/topic/pri... (https://www.passthemsra.com/topic/pri...)
🧠 Flashcards:
https://www.passthemsra.com/topic/pri... (https://www.passthemsra.com/topic/pri...)
💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/pri... (https://www.passthemsra.com/topic/pri...)
🚀 Rapid Quiz:
https://www.passthemsra.com/topic/pri... (https://www.passthemsra.com/topic/pri...)
🎓 Full Course:
https://www.passthemsra.com/courses/g... (https://www.passthemsra.com/courses/g...)

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Episode link: https://play.headliner.app/episode/27...