Could This Be PBC or Something Different?
Subject Profile: 49-year-old female, height 5'2", weight 140 pounds, residing in the USA. Medical Diagnoses: - Attention Deficit Hyperactivity Disorder (currently managing with Vyvanse 40mg) - Hypothyroidism (treated with Unithroid 5mcg) Supplemental Vitamins: - Magnesium glycinate (250mg) - Fish oil (1250mg) Past Surgical Interventions: - ACL reconstruction in 2011 - LASIK eye surgery in 2018 - Complete oophorectomy and hysterectomy performed in November 2020 - Partial thyroidectomy conducted in January 2022 Additional Information: I am not undergoing hormone replacement therapy due to a heightened risk for breast cancer, navigating menopause without any support. My mother has been diagnosed with Sjögren's syndrome. Symptomatology: I frequently contend with bouts of extreme fatigue that can strike unexpectedly, leaving me incapacitated at times. Post-LASIK, my eye occasionally experiences severe dryness, akin to being pricked with a needle. I also notice significant swelling in my hands during the night. Furthermore, I sometimes experience visual disturbances, where my vision can't seem to focus properly, prompting me to increase my display resolution to 150% for work purposes. Joint discomfort is sporadic, predominantly affecting my left hand and right hip. Additionally, I have noticeable skin reactions to viral infections, presenting as itchy rashes. My allergy test indicated a mild reaction to egg whites, with no significant responses to other allergens. Laboratory Findings: Since around 2021, my AST and ALT levels have been gradually increasing (current AST: 57, ALT: 84). Healthcare professionals have reassured me that my levels are within a normal range, while others express that they aren't high enough to raise alarm. A doctor who monitors my results closely—primarily due to previous use of Tamoxifen, which I discontinued because of adverse effects—has referred me to a hematologist. The hematologist performed a fibroscan, which displayed normal results. However, he proceeded to order an AMA test, returning a figure of 162.5. He mentioned that these results suggest a strong possibility of Primary Biliary Cholangitis (PBC), but since my alkaline phosphatase level is 171, which doesn't meet the threshold of being 1.5 times the normal value, a liver biopsy has been scheduled for September 9th. Inquiry: Is there a likelihood that I have PBC, or might this be attributed to another condition? If beneficial, I can provide images of my blood test results from the last few years for additional context.
Answers (1)
8/28/2025, 5:13:29 PM
OpenHealth AI
Main Points: Based on your symptoms and lab results, there is a possibility that you may have Primary Biliary Cholangitis (PBC), particularly given the elevated AMA level. However, other conditions could also explain your symptoms and lab findings. It's crucial to await the results of the liver biopsy for a definitive diagnosis.
Explanation: Your symptoms of extreme fatigue, joint discomfort, and visual disturbances, coupled with the laboratory findings (notably the elevated AMA and liver enzymes), raise the suspicion of PBC. PBC is an autoimmune liver disease that affects bile ducts and can lead to liver damage over time. However, symptoms such as joint pain and skin reactions can also relate to other autoimmune conditions, especially considering your family history of Sjögren's syndrome.
With your alkaline phosphatase level being borderline, it's good that you're undergoing further evaluation with a liver biopsy. This procedure will help clarify whether there is any significant liver damage and confirm a diagnosis if PBC is indeed present.
Next Steps:
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Attend the Biopsy Appointment: This is critical for confirming or ruling out PBC or other liver conditions. Ensure you discuss any questions or concerns with your healthcare provider about the procedure.
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Track Symptoms: Keep a diary of your symptoms, noting when they occur, their intensity, and any triggers you might notice. This can be valuable information for your healthcare team.
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Hydration and Nutrition: Ensure you stay well-hydrated and consider a balanced diet rich in nutrients to support your overall health. Focus on foods high in antioxidants (like fruits and vegetables) which may help manage inflammation.
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Follow Up with Healthcare Providers: After your biopsy, follow up with the specialist to understand the results and discuss potential management options based on your diagnosis.
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Monitor and Manage Symptoms: Continue managing your fatigue and discomfort by establishing a routine that includes rest and gentle exercises, as tolerated. You may also consider consulting with a physical therapist for joint discomfort.
If you have any immediate concerns about your symptoms worsening, don't hesitate to seek medical advice before your scheduled biopsy.
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