Hi there,

I am writing to you to get your expert opinion in regards to my recent lab results, symptoms, and Hx.

Patient details:

Age 24y 10m (9/12/1989)
Caucasian (Australian)
Male
Height: 186cm (6ft).
Weight: 105kg
Build: Muscular/Overweight with fat in abdominal and thigh region.
Blood type: B Negative
Occupation: Paramedic
Family Hx: Father (65yo) Hx of Lupus SLE, which manifests mainly as dermatitis; and, Deep Vein Thrombosis. Mother: (60yo) Hx Obese Osteoporosis, Lymphedema. Uncle (Mother's Twin) Hx Obese, Coronary Heart Disease requiring Triple Bypass surgery.

Patient PMHx: 5 years old patientfeeling of fatigue, low/absent libido, and mood disorder (2012 Dx Depression/Anxiety); ?Gynecomastia (however, normal testosterone levels); ?Gout (2 years), pain in right Hallux which comes and goes, however, Uric acid levels normal; Anal Fissure 1 year ago, progressed to internal haemorrhoids (unconfirmed) with occasional pain in bowel.

3 years old patientago a Live Function Test result came back elevated, although, I cannot remember which test.

Current complaint: Right Upper Quadrant pain described as 'dull', not constant, comes and goes every couple of days. Sometimes I get pain in different quadrants (LUP & LLQ).

Recent test results came back: Moderate positive for Cytoplasmic Antibodies ("Anti-Smooth Muscle and Anti-Mitochondrial, if clinical indicated"). ****Please see test results attached****

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My main query is:

- Do my symptoms and lab results suggest a Dx of Primary Biliary Cirrhosis?

- What is your provisional Differential Diagnosis?

- If yes, how urgently should I seek medical help? (I am currently working on a remote mine site in the desert of Western Australia). Am I able to wait for 10 days before I see my general practitioner (GP) again?

- When I see my GP, what tests should I have done? (i.e. LFT, CBC, Hormones, Liver Biopsy etc..)

- is there any other advise you can give me?



Sincerely yours,



John Trewin