Answer 1 Primary biliary cirrhosis. This patient’s elevated alkaline phosphatase is consistent with cholestasis, the predominant manifestation of primary biliary cirrhosis. Patients with this disease also may present with pruritus. Primary biliary cirrhosis has a 9:1 female to male ratio, making it more likely than primary sclerosing cholangitis. The patient denies a history of alcohol use, and results of liver function tests are not consistent with that of alcoholic cirrhosis (also known as Laennec’s cirrhosis) (eg, 2:1 ratio of aspartate aminotransferase/alanine aminotransferase). Nonalcoholic steatohepatitis is not likely to present with cholestasis. Click here to return to the questions

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