My Liver Biopsy

[Ellyne]

Hi All,

I have been diagnosed with PBC and started taking Urso 300mg 3 times a day. My question is how do I know for sure if it is PBC? My biopsy report said that I have granulomatous duct injury suggestive of PBC but that there are clinical and histologic features that are atypical for that disease. I had a normal ALP, ,mildy elevated ALT/AST but an AMA positive 1:640, an absence of keratin 7 positive cholestatic hepatiocytes, only rare loss of bile ducts in portal tracts without granulomas and persistence of canal of hiring/ductular profiles. The report goes on to say that granulomatous mimics of PBC should be considered clinically, including sarcoidosis and drug/toxin induced liver injury. So I took ACE blood test and I was in normal range so that ruled out sarcoidosis. Gastro feels it is definitely PBC but I keep having doubts because of the some of the info in the above report. Any advice would be greatly appreciated.

Ellyne

[Aprilbalech]

Hi ellyne do you have any symptoms? If so what are they? Your labs are very similar to mine after antibiotics.

[Ellyne in reply to Aprilbalech]

I do not have any symptoms. I went to the gastro bec. I was constipated and nothing seemed to work so he started testing me for everything under the sun. Turned out, I needed to get my synthroid adjusted and when I did that the constipation cleared up. I was not on antibiotics prior or at the time of testing.

[Hidden in reply to Ellyne]

My hair stylist has cirrhosis because of Tylenol. She had endometriosis. She said that she couldn’t function on hard meds so she took several Tylenol and it destroyed her liver

[Aprilbalech in reply to Ellyne]

Thank you Ellyne.

[Ellyne]

Wow! I took plenty of Tylenol over the years for my neck. Also nsaids.

[gwillistexas]

Alk Phos & bilirubin have to do with bile duct cells. AST & ALT indicate liver cell damage.

[periwinkle88]

I'm going to have to pull out my biopsy report and compare. My situation is very similar - AMA 1:640, mildly elevated ALT and AST (until I started urso, when they both went down to solidly in the middle of the normal range), normal alk phos (always the lower end of normal, actually), normal, if not optimal, bilirubin. The first pathologist couldn't find any evidence of PBC on the biopsy images. A follow up with a PBC specialist found one tiny lesion that was classic PBC, and I was diagnosed very early stage PBC. I didn't go on urso for four years after the diagnosis, and my alkaline phos never budged from the lower end of normal. Definitely not typical of PBC, from what I've read. I've been curious as to why. A variant of PBC? Why? And what's the difference between this presentation and the more typical presentation of elevated alk phos but usually normal ALT and AST.

[Ellyne in reply to periwinkle88]

After reading your reply I see you said normal, if not optimal bilirubin. I have 3 bilirubin results: Bili total, Bili direct, and Bili Indirect. All three results within normal range, specifically less than half way. My question is What is optimal? Thanks for replying to me before. I am so consumed with all of this. It is basically all I can think about.

[periwinkle88 in reply to Ellyne]

The lower end of the scale is better for bilirubin, from what I understand. High bilirubin indicates problems.

[Lili1214]

Hi Ellyne,

I have been dx with PBC as well due to AMA 1:640. I had an elevated ALT during a routine physical which lead to more blood tests revealing the high AMA. I also had an MRI which showed normal liver, normal bile ducts with no damage, normal pancreas, etc... My Gastro put me on 500mg ursodiol 2x/day. Today my blood work is in the normal range - I don't have any symptoms except clay colored stools, fatigue and episodes of upper right quadrant discomfort.. I've not had a liver biopsy. Confusing disease...

[Ellyne in reply to Lili1214]

I couldn't agree more. Thank you for your reply.

[Ellyne]

Thank you periwinkle88 for the information. I want to learn as much about PBC as I can.