AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 32-year-old female presents with a 4-week history of worsening fatigue, generalized itching, dark urine, and pale stools. She denies alcohol use or new medications. On physical examination, she has scleral icterus and excoriations on her skin. Liver function tests show elevated alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT), with mildly elevated bilirubin. Which of the following is the most likely diagnosis?
- APrimary biliary cholangitis (PBC)
- BCholedocholithiasis
- CAlcoholic hepatitis
- DAcute viral hepatitis
Show answer & explanationAnswer & explanation
Correct answer: A. Primary biliary cholangitis (PBC)
The patient's symptoms (fatigue, generalized itching, dark urine, pale stools, icterus, excoriations) combined with laboratory findings of elevated ALP and GGT (suggesting cholestasis) and female gender are highly characteristic of primary biliary cholangitis (PBC). PBC is an autoimmune liver disease causing progressive destruction of small bile ducts.
Why the other options are wrong
- B. Choledocholithiasis (bile duct stones) would cause acute, often colicky, pain and more abrupt onset of jaundice, but less likely chronic itching and fatigue without pain.
- C. Alcoholic hepatitis is ruled out by the denial of alcohol use and would typically show a higher AST/ALT ratio (often >2:1) rather than predominantly cholestatic enzyme elevation.
- D. Acute viral hepatitis typically presents with significantly elevated AST/ALT, and less prominent cholestatic features like severe itching or pale stools.
Cholestasis Evaluation
The diagnostic process for impaired bile flow, leading to accumulation of bile components in the blood and characteristic symptoms.
- Symptoms: pruritus, jaundice, dark urine, pale stools, fatigue.
- Lab findings: elevated ALP and GGT.
- Differentiate intrahepatic vs. extrahepatic causes.
Memory trick: Itching, Jaundice, and ALP High, PBC's name you must apply.