Question

Commonest early symptom of primary biliary cirrhosis is

• A. Pruritus
• B. Jaundice
• C. Hepatomegaly
• D. Pale stools

Hint:

Think about the skin symptom caused by early build up of bile salts, before jaundice appears.

Answer 1

The Correct Option is A

This question asks which symptom of primary biliary cirrhosis typically shows up first.

1. Pruritus: Retained bile acids build up in the skin early in the disease, causing itching that classically precedes jaundice and other symptoms by months to years, making it the most common early symptom.
2. Jaundice: This usually develops later, once bile duct destruction has progressed enough to impair bilirubin excretion significantly.
3. Hepatomegaly: This is a physical examination finding that appears as the disease advances, not typically the presenting early symptom.
4. Pale stools: These result from reduced bile reaching the gut and tend to appear with more advanced cholestasis, later in the disease course.

Since bile salt build up in the skin happens early, well before jaundice, pruritus is the earliest and commonest presenting symptom.

Let's summarize:

• Primary biliary cirrhosis progresses slowly, with bile salts accumulating in the skin before major liver dysfunction appears.
• This makes pruritus the classic earliest symptom, ahead of jaundice, hepatomegaly, or pale stools.

So the commonest early symptom is pruritus.