Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease that selectively destroys intrahepatic small bile ducts. Destruction leads to bile retention, hepatocyte damage, and progressive fibrosis. Onset is insidious; many patients are diagnosed while still asymptomatic through routine elevation of alkaline phosphatase. Recognising the evolving clinical picture allows early therapy and monitoring of complications. Early-stage signalsFatigue: the most frequent first complaint, unrelated to disease severity, often fluctuating and out of proportion to liver biochemistry.Pruritus: initially nocturnal, localized to palms or soles, later generalized; can be intermittent or persistent, sometimes worsened by heat, stress, or pregnancy.Dry eyes and dry... Learn more