Match each constellation of clinical, serologic, and diagnostic findings to the most appropriate hepatobiliary disorder.
- Elevated alkaline phosphatase, positive anti-mitochondrial antibodies, and florid duct lesions on liver biopsyPrimary biliary cholangitis
- Elevated transaminases, elevated serum IgG levels, positive anti-smooth muscle antibodies, and interface hepatitis on liver biopsyAutoimmune hepatitis
- Elevated alkaline phosphatase, alternating strictures and dilations of the bile ducts on imaging, and a strong association with inflammatory bowel diseasePrimary sclerosing cholangitis
- Elevated transaminases, elevated transferrin saturation, bronze skin hyperpigmentation, and a high risk of developing arthropathyHereditary hemochromatosis
Answer
The findings match as follows: anti-mitochondrial antibodies and florid duct lesions indicate Primary biliary cholangitis; elevated IgG and anti-smooth muscle antibodies indicate Autoimmune hepatitis; strictures/dilations associated with inflammatory bowel disease indicate Primary sclerosing cholangitis; and elevated transferrin saturation with bronze skin indicates Hereditary hemochromatosis.
Each constellation of findings points to a distinct hepatobiliary pathology. Primary biliary cholangitis is driven by intrahepatic duct destruction with positive anti-mitochondrial antibodies. Autoimmune hepatitis causes hepatocellular damage with interface hepatitis and positive anti-smooth muscle antibodies. Primary sclerosing cholangitis affects the entire biliary tree and is linked to inflammatory bowel disease. Hereditary hemochromatosis is an iron overload syndrome presenting with elevated transferrin saturation and characteristic extrahepatic manifestations like bronze skin and arthropathy.
Step-by-Step Solution
Key Concept
Diagnostic differentiation of chronic liver and biliary diseases based on specific autoantibodies, imaging findings, and systemic associations.