FIGURE 1.

Approach to the diagnosis of PBC. The assessment of patients with cholestasis whether symptomatic or not should include a liver ultrasound and testing for the AMA in serum. A positive AMA in this setting is sufficient to make the diagnosis of PBC. PBC-specific ANAs, ie, anti-sp100 and anti-gp210, can aid in the diagnosis of PBC in individuals with cholestasis and negative AMA serology. Liver biopsy is reserved for those with unclear diagnosis after serologic workup, or when a coexisting process is suspected, including fatty liver disease and autoimmune hepatitis. Abbreviations: AMA, antimitochondrial antibody; AMS, altered mental status; ANAs, antinuclear antibodies; MRCP, magnetic resonance cholangiopancreatography; PBC, primary biliary cholangitis; US, ultrasound.