Question

Commonest early symptom of primary biliary cirrhosis is

• A. Pruritus
• B. Jaundice
• C. Hepatomegaly
• D. Pale stools

Hint:

Think about the skin symptom caused by early build up of bile salts, before jaundice appears.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
We need to identify the symptom that most commonly appears first in primary biliary cirrhosis, an autoimmune disease that slowly destroys the small bile ducts within the liver.

Step 2: Key Formula or Approach:
Because primary biliary cirrhosis progresses slowly and bile salts build up in the blood and skin well before the liver's other functions are significantly impaired, one particular symptom related to bile salt accumulation tends to appear earliest, often before jaundice develops.

Step 3: Detailed Explanation:
Pruritus, or itching of the skin, is classically the earliest and most common presenting symptom of primary biliary cirrhosis, caused by retained bile acids irritating the skin, and it can appear months to years before any other sign of liver disease shows up.
Jaundice does occur in primary biliary cirrhosis, but it typically develops later in the disease course, once bile duct destruction has progressed enough to significantly impair bilirubin excretion, so it is not usually the earliest symptom.
Hepatomegaly can be found on examination as the disease advances, but it is a physical sign found on examination rather than an early symptom that brings the patient to seek care.
Pale stools result from reduced bile reaching the intestine and tend to appear later in the disease, alongside more advanced cholestasis, rather than being the earliest symptom.

Step 4: Final Answer:
So the commonest early symptom of primary biliary cirrhosis is pruritus.