Initially your doctor should ask you what if any symptoms you have been having. You will also be asked about your immediate family and whether there is PBC in your family history. Doctor's will focus on blood relatives, mothers, fathers and siblings, but certainly any instance of PBC in a family should be reported. Even if you yourself are not showing any symptoms, blood tests should be taken on a regular basis to check for liver function.
Liver Function Tests or LFT's
These will probably be the first tests your doctor orders. These Liver Function Tests will look at specific levels on a given substance. For instance in PBC, liver enzymes such as AST & ALT: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) typically become elevated when liver disease or a comprised liver occurs. Perhaps the most telling of the three however is ALP: Alkaline Phosphatase. The ALP is almost always more elevated than the AST and ALT enzymes. As the disease progresses, the AST and ALP may remain slightly elevated while the ALP can become very high.
Another test to check for is Serum Immunoglobulin M or IgM. This can also become elevated as can the gamma Glutamyl Transpeptidase or GGT. The latter is perhaps more telling, as the GGT actually proves that a rise in ALP levels is specific to the liver, rather than a bone disease which may also cause rises in ALP numbers.
Doctors will also check Bilirubin levels. At an early stage of PBC, these can be less telling because the level may be normal or only slightly elevated. Later on in PBC, bilirubin levels become more significant as when the levels rise above a certain point, it is often used as an indicator to place a person on the transplant list.
So for the sake of a hypothesis, let's imagine that your tests above do come back indicating PBC meaning:
- Moderate elevations of AST & ALT
- Higher elevation (compared to AST & ALT) of ALP
- Elevated IgM
- Elevated GGT
- Normal or slightly elevated bilirubin.
What happens next?
AMA & ANA Testing
My doctor at this point referred me to a gastroenterologist. Your doctor may very well perform the next set of tests him or herself. There is nothing wrong with that; you will be referred to a specialist as and when the need arises and it may be cheaper for you to have your labs done by your PCP.
Go To Page: 1 2
