<prompt> Most common symptom of primary biliary cirrhosis isPruritisAbdominal painJaundiceBleeding  <response>: Answer is A Pruritis: The earliest symptom is pruiritis which may be either generalized or limited initially to the plams and soles. -- Harrison Primary Biliary Cirrhosis Primary biliary cirrhosis is a disease characterized by chronic inflammation and fibrous obliteration of intrahepatic bile ductules due to an unknown primary stimulus. Etiology pathogenesis : PBC is believed to be due to an autoimmune Q etiology as it is often associated with other autoimmune disorders Q such as I . CREST Q :Calcinosis, Raynauds, Esophageal dysmotility, Sclorodactyly Talenglectasia SICCA SYNDROME Autoimmune thyroiditis Q Renal tubular acidosis Antimitochondrial Antibody IgG is positive Clinical feature : Most patients are asymptomatic Q Pruritis is commonest earliest symptom Q Jaundice Melanosis: gradual darkening of exposed areas of skin Q Deficiency of fat soluble vitamins due to malabsorption Q Vit D deficiency : bone pain - osteomalacia Q Vit K deficiency : bleeding -- bruising 2 Vit A deficiency : Night blindness Q Xanthelisman xanthomasQ due to protracted elcvaliar of serum lipids. Lab Findings : T1 Serum alkaline phosphatase Q 2-5 fold Positive antimitochondrial antibody :Q Sensitive and specific Hyperlipidemia Q 