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Answer 3
  1. PBC. PBC is a progressive cholestatic liver disease of unknown etiology. PBC occurs as a result of a T-cell-mediated assault on the small intralobular bile ducts and is almost always seen in middle-aged women. Pruritus is common in patients with PBC and can be severe. Patients with PBC also frequently have periorbital xanthomas caused by hyperlipidemia. In PBC, the cholangiogram is usually normal at presentation, whereas in PSC it is almost always abnormal, demonstrating diffuse intra- and extrahepatic ductal abnormalities. Choledocholithiasis would have been seen during ERCP. SSC can mimic PBC but is typically caused by chronic benign biliary obstruction, which this patient does not have. Acute hepatitis A would manifest with a marked elevation of the patient’s transaminase levels.

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