Primary biliary cholangitis may not have symptoms early on. Sometimes, your doctor finds out you have it because of a routine blood test.
Other times, you may have symptoms, so your doctor may order tests. You may feel tired, or have itchy skin, dry eyes, or a dry mouth. As the disease gets more serious, you may also have other signs, like:
- Yellow skin and eyes
- Pain and swelling in your abdomen
- Joint, bone, or muscle pain
- Darkened skin
- Swollen feet or ankles
If your doctor thinks you might have PBC, they’ll do a physical exam and ask you about your family history. Although the disease isn't directly passed down from parents to children, there seems to be some sort of family link.
They’ll probably order some tests. Those can include blood tests, imaging tests, and maybe a liver biopsy.
Blood Tests
Your doctor will want to do liver function tests to see how the organ is working. They check the levels of certain enzymes that show if you have liver disease.
The tests also help spot damage to the ducts that carry bile away from your liver. This fluid is key for digestion because it helps your body absorb fats, cholesterol, and other fluids you don’t need. When your bile ducts are injured, which is what happens with PBC, those substances hang around in your liver, and the organ doesn’t work the way it should.
The doctor will also do a blood test that checks for something called anti-mitochondrial antibodies, or AMAs. People with PBC almost always have them. If you don’t have PBC, you won’t have AMAs.
Other Tests
Your doctor may also want a closer look at your liver, bile ducts, and the surrounding area. The tests may include:
Ultrasound: This test uses high-frequency sound waves to check your liver and bile ducts for damage.
MRCP (magnetic resonance cholangiopancreatography) is a specialized MRI that creates detailed images of your organs and bile ducts.
CT scan: This special type of X-ray can also check for problems in and around your liver.
ERCP: A procedure called an endoscopic retrograde cholangiopancreatography (ERCP) lets your doctor see your bile and pancreatic ducts. You’ll get medicine to make you go to sleep. The doctor will put a small flexible tube with a light and camera on the end into your mouth. It slides through your body to your ducts. Then your doctor will inject dye into the area and take X-rays to look for problems. ERCP may be used to repair certain problems like a blockage of the ducts.
Liver Biopsy
Your doctor may remove a small sample of your liver tissue with a needle and send it to a lab. This test is usually done at a hospital or medical center, so you can get medicine to make you sleepy and control pain. The sample will be sent to a lab, where a doctor will look at it under a microscope. Not everyone needs this test. You might get one if your AMA blood test is negative but you have other signs of PBC.