Cirrhosis MCQ — NEET PG Practice Question | NEETPGAI
Cirrhosis
medium
microscope Pathology
A 48-year-old woman with hepatitis C virus-related cirrhosis and a 55-year-old man with primary biliary cholangitis (PBC)-related cirrhosis both present with portal hypertension. Which feature best distinguishes PBC-related cirrhosis from HCV-related cirrhosis?
A. Ascites and splenomegaly from portal hypertension
B. Hepatitis C antibodies and lymphoid aggregates in portal tracts
C. Elevated direct bilirubin and jaundice
D. Presence of antimitochondrial antibodies (AMA) and bile duct destruction
Explanation
Distinguishing PBC-Related from HCV-Related Cirrhosis
Pathognomonic Features of PBC
Key Point
Primary biliary cholangitis is characterized by autoimmune destruction of intrahepatic bile ducts, with antimitochondrial antibodies (AMA) being present in >95% of cases. This autoimmune cholestasis is the defining feature that distinguishes PBC from HCV-related cirrhosis.
Comparative Pathology
Table
Feature
PBC-Related Cirrhosis
HCV-Related Cirrhosis
Antimitochondrial antibodies (AMA)
Present (>95%)
Absent
Bile duct destruction
Characteristic (early)
Absent
Lymphoid aggregates/follicles
Mild to moderate
Prominent (hallmark)
Hepatitis C antibodies
Negative
Positive
Steatosis
Minimal
Often present
Portal inflammation
Moderate
Often severe
Granulomas
Present (around ducts)
Absent
Histological Hallmarks of PBC
High-YieldNEET PG
The diagnostic triad of PBC includes:
1.
Bile duct destruction — Loss of intrahepatic bile ducts (>50% loss = stage 3–4)
2.
Granulomatous inflammation — Non-caseating granulomas around damaged ducts
Lymphoid aggregates/follicles — B-cell-rich collections in portal tracts (pathognomonic)
2.
Steatosis — Often present, correlates with viral load
3.
Bile duct proliferation — Reactive, not destructive
4.
Minimal granulomas — Absent or very rare
Serological Discrimination
Clinical Pearl
PBC: AMA-M2 positive (>95%), anti-centromere antibodies (ACA) in 50%, anti-sp100 in 25%
HCV: HCV antibody positive, HCV RNA detectable by PCR
These serology results, combined with histology showing bile duct destruction in PBC versus lymphoid aggregates in HCV, provide definitive discrimination.
Why Other Features Are Non-Discriminatory
Hepatitis C antibodies and lymphoid aggregates: While these are characteristic of HCV, they do not distinguish PBC from HCV—they only confirm HCV etiology
Elevated direct bilirubin and jaundice: Both conditions can present with cholestasis and jaundice as cirrhosis progresses; this is not discriminatory
Ascites and splenomegaly: These are manifestations of portal hypertension from any cirrhosis etiology and are not specific to either condition
Robbins 10e Ch 18
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