Q&A Medicine>>>>>Gastroenterology
Question 47#

A 43-year-old woman presents with jaundice, right upper quadrant pain, and bothersome pruritus for the past 6 months. Her past medical history is significant for asthma and she only takes inhaled albuterol as needed. Laboratory testing reveals positive anti-mitochondrial antibodies and the patient is diagnosed with primary biliary cirrhosis.

Which of the following is the best initial treatment for this patient?

a. Liver transplantation
b. High-dose steroids
c. Biliary stent placement
d. Ursodeoxycholic acid

Correct Answer is D

Comment:

Ursodeoxycholic acid. This patient has been diagnosed with primary biliary cirrhosis (PBC) as indicated by positive anti-mitochondrial antibodies, jaundice, right upper quadrant pain, and pruritus. PBC is a chronic autoimmune disease of the liver that is associated with intrahepatic duct destruction and cholestasis. The initial drug of choice is ursodeoxycholic acid because it not only reduces cholestasis and improves symptoms but it also has been shown to slow disease progression and therefore increases the time before a liver transplant is needed. (A) Liver transplantation is the only curative treatment in PBC; however, this is only an option once the disease has evolved to a cirrhotic state. (B, C) Neither high-dose steroids nor biliary stent placement has been shown to be effective in the treatment of PBC mainly because biliary stents do not affect intrahepatic bile ducts that are involved in the disease.