Zero ad trackers.We never sell your data.

Home / For clinicians / Diagnosis guides / Primary biliary cholangitis (PBC) / Checklist

Primary biliary cholangitis (PBC): Suspect-and-test checklist for clinicians

A one-page worksheet that turns the full Primary biliary cholangitis (PBC) diagnosis guide into something you can use at the point of care: what to look for, what to order, which results should not end the workup, and who else to test or refer.

Who it is forClinicians and care teams who may see Primary biliary cholangitis (PBC) before it is diagnosed, including primary care, the specialists named in the guide, and referral or genetics coordinators.
When to use itWhen Primary biliary cholangitis (PBC) is on the differential, when a patient has several red flags, or when you are preparing a referral or a second opinion.

How to use it, section by section

  1. Red flags present: Tick each finding the patient has. They are grouped by body system so you can scan quickly.
  2. Already labeled as: Tick earlier diagnoses on the chart that the sources say are often given first.
  3. Family to test: Note relatives who may need testing, and record when symptoms began and which specialists have already been seen.
  4. Testing, in order: Tick each test as you order it and write the result on its line. The order follows the published sources.
  5. Results that do not rule it out: A reminder of findings that can look reassuring but do not exclude Primary biliary cholangitis (PBC).
  6. Specialists: Tick the referral, then write who it went to and any notes.
Two ways to fill it inPrint it blank and write on it, or tick boxes and type on this screen first, then print or save as a PDF. Keep it with the chart or send it with the referral.
PrivacyNothing you type is sent or saved. It stays in this browser tab and disappears when you close it. Use patient initials, not full identifiers.

What it is not: Not a diagnostic score, a protocol or coding advice. It summarizes published sources, and clinical judgment and the treating clinician govern. Every point is sourced in the full Primary biliary cholangitis (PBC) guide.

One Letter page. Use your browser's print or save as PDF.Full guide with sources
Suspect-and-test checklist
Primary biliary cholangitis (PBC)

Autoimmune bile duct disease. Start from a persistently raised ALP with no other cause, then check AMA.

ICD-10-CMK74.3Trial Friend for Clinicians

1Red flags present

Labs

Symptoms

Skin and examination

Autoimmune disease and family

2Already labeled as

3Family to test

4Testing, in the order the sources describe

  1. Repeat ALP with GGTGGT or conjugated bilirubin supports a liver source. Over 6 months counts as chronic.
    Result
  2. History and drug reviewPrescribed, herbal and anabolic agents; alcohol.
    Result
  3. Abdominal ultrasoundFirst imaging test, to exclude extrahepatic cholestasis.
    Result
  4. AMA and ANAAMA above 1 in 40 with cholestatic tests is usually sufficient, per BSG.
    Result
  5. sp100 and gp210 if AMA negativeSpecific but not sensitive. No biopsy needed if positive, per AASLD.
    Result
  6. AASLD criteria: 2 of 3Cholestatic ALP; AMA or sp100 or gp210; compatible histology.
    Result
  7. MRCPUnexplained cholestasis, especially if antibodies are negative.
    Result
  8. Liver biopsyNo PBC-specific antibodies, ALT over 5 times normal, or suspected AIH or steatohepatitis.
    Result
  9. Thyroid, celiac and Sjögren screenBSG suggests it at baseline once PBC is diagnosed.
    Result

5Results the sources say do not rule it out

  • Negative AMA. Absent or low titer in 5% to 10%; check sp100 and gp210.
  • Gallstones on ultrasound. Common and usually silent in PBC.
  • No itch. Many patients never have it.
  • Positive AMA with normal ALP. Not PBC by itself; guidelines advise repeat liver tests.
  • Raised ALT or ANA. Common in PBC and not proof of overlap.

6Specialists the sources name

Diagnosis code: K74.3 Primary biliary cirrhosisCodes patients often carry before diagnosis are listed in the online guide.
Full guide and sourcesEvery point here is sourced in the online guide, which also has a patient note to print.
Trial Friend, trialfriend.com/for-clinicians. Key sources: AASLD 2018 guidance; EASL 2017 guideline; BSG/UK-PBC 2018 guideline; AGA/AASLD 2026 guideline; Dahlqvist 2017 AMA study; Zein 2003 biopsy study; all 24 with links in the online guide. Checked November 11, 2026. A reference checklist for licensed clinicians that summarizes published sources. It is not a diagnostic tool, a score or a protocol, and it does not replace clinical judgment, local practice or the prescribing information. Not coding advice. Trial Friend never receives anything written or typed on this sheet.