Primary biliary cholangitis and primary sclerosing cholangitis Quiz: Ace Your Exams

A 38-year-old woman comes to the clinic for a follow up. At her initial visit a week ago, routine labs were ordered which revealed an elevated alkaline phosphatase level, which was then confirmed with repeat testing. Review of systems is significant for mild pruritus. She has no family history of liver disease. Past medical history is noncontributory. Vitals are within normal limits. Physical examination is unremarkable. Laboratory findings are shown below. Right upper quadrant ultrasound shows a normal appearing gallbladder and biliary tract. Which of the following additional signs or symptoms would most likely be present given this patient’s likely underlying condition?  

Laboratory value	Result	Reference range
Complete Blood Count
Hemoglobin	13.5 g/dL	12-16 g/dL
Leukocyte count	5,500/mm3	4,500-11,000/mm3
Platelet Count	200,000/mm3	150,000-400,000/mm3
Serum Chemistry
Sodium	142 mEq/L	136-146 mEq/L
Potassium	4.2 mEq/L	3.5-5 mEq/L
Chloride	95 mEq/L	95-105 mEq/L
Creatinine	1.2 mg/dL	0.6-1.2 mg/dL
Alanine aminotransferase	20 U/L	8-40 U/L
Aspartate aminotransferase	21 U/L	8-40 U/L
Serum albumin	4 g/dL	3.5-5.5 g/dL
Serum total bilirubin	0.8 mg/dL	0.1-1 mg/dL
Total protein	6 g/dL	6-7.8 g/dL
Alkaline phosphatase level	220 U/L	20-70 U/L
Antimitochondrial antibodies (AMA)	positive	negative