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Abstract: The main character of this case is a 56-year-old sister Gu, who visited the clinic for recurrent abnormal liver function, along with chronic weakness and pruritus. Checking the indicators commonly associated with liver function impairment, serum anti-mitochondrial antibody (+) was found, and the diagnosis of primary biliary cholangitis was made in combination with clinical manifestations, and ursodeoxycholic acid tablets were given for symptomatic treatment, such as bile relief.
Basic information】Female, 56 years old
Disease Type】Primary biliary cholangitis
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan】Medication (ursodeoxycholic acid tablets)
Treatment Period】7 weeks of inpatient treatment, 1 month of outpatient review
Effectiveness】hepatic function improved, weakness and itchy skin symptoms reduced
I. Initial consultation
Ms. Gu has had abnormal liver function for more than 1 year, mainly transaminases and bilirubin are mildly elevated, accompanied by fatigue and itchy skin, etc. After symptomatic treatment at the local hospital, the situation has improved, but it tends to recur, so she wants to come to our hospital for further examination. In this case, we should first rule out viral hepatitis and drug-related liver damage, so we ordered Gu to undergo routine hepatitis B and C virus screening in the outpatient clinic, but the virus screening was negative, and Gu was not taking long-term oral medication. She was admitted to the hospital with “liver function abnormalities of unknown origin”.
II. Treatment history
After admission, the abdominal ultrasound and abdominal CT examination were completed, and no bile duct stones or biliary tumors were found, but the liver was found to be cirrhotic and atrophic. Then the examination of liver antigen antibody profile, hepatitis A, hepatitis E and antinuclear antibody were done and found that: serum anti-mitochondrial antibody (+), other examination indexes were (-), based on the above examination combined with clinical manifestations, the diagnosis was primary biliary cholangitis, also known as primary biliary cirrhosis. According to the current clinical manifestations, Sister Gu belongs to the early stage of the disease, mainly with cholestasis as the main manifestation, so the current main treatment is biliary, given oral ursodeoxycholic acid tablets biliary treatment, after about 1 week of treatment, Sister Gu’s liver function improved significantly, weakness, skin itching symptoms have significantly improved, Sister Gu continued oral ursodeoxycholic acid tablets treatment and was discharged after 7 days of hospitalization.
III. Treatment effect
At present, Ms. Gu is mainly in the early stage of the disease with mild symptoms, so the main treatment is biliary treatment. After taking ursodeoxycholic acid tablets orally, her liver function improved significantly, and her symptoms of fatigue and skin itchiness were significantly reduced, and her appetite also improved. At present, the most important treatment for Gu is to continue the biliary treatment, so she continued to take oral ursodeoxycholic acid tablets and was discharged after 7 days of hospitalization. One month after her discharge, she returned to the hospital for a review of her liver function and found that her transaminases and bilirubin levels were close to normal, her fatigue was better than before, and her itchy skin disappeared. She was very satisfied with the treatment effect.
IV. Notes
She is glad that after treatment, her liver function has improved and her weakness and itchy skin symptoms have been reduced. Long-term oral ursodeoxycholic acid cholestatic treatment requires regular review, because the liver function damage and cirrhosis process caused by primary biliary cholangitis is irreversible, there is no curative medicine, all we can do is to slow down the development of the disease. Therefore, Ms. Gu should be reviewed every six months, and the treatment plan should be adjusted promptly if there is any change in her condition.
V. Personal insight
Primary biliary cholangitis, also known as primary biliary cirrhosis, is a disease in which intrahepatic biliary stasis is the main manifestation. Its pathogenesis is related to genetic, infectious and environmental factors, and may also be related to autoimmunity, and is commonly seen in middle-aged and elderly women. The most important thing in the early stage of the disease is a clear diagnosis and then timely cholestatic treatment, as in the case of this sister Gu, only early cholestasis occurred, therefore, in order to delay the development of the disease, the disease should be detected and diagnosed in time and treated by oral cholestatic drugs to achieve a better treatment effect.