MEDizzy - A 40-year-old white female complains of pruritus. Physical

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Gastroenterology

A 40-year-old white female complains of pruritus. Physical examination reveals xanthelasma and mild splenomegaly. She has an elevated alkaline phosphatase, but her transaminases are normal. The antimitochondrial antibody test is positive. Match the clinical description with the most likely disease process.

ExplanationPrimary biliary cirrhosis usually occurs in women between the ages of 35 and 60. The earliest symptom is pruritus, often accompanied by fatigue. Serum alkaline phosphatase is elevated two- to fivefold, and a positive antimitochondrial antibody test greater than 1:40 is both sensitive and specific.