Primary Sclerosing Cholangitis (cont.)
How is the diagnosis of primary sclerosing cholangitis made?
The diagnosis of primary sclerosing cholangitis is suspected from the symptoms (such as fatigue,
itching, and jaundice) and abnormal laboratory tests (such as abnormally
elevated blood levels of alkaline phosphatase and other liver enzymes); and is
confirmed by demonstration of abnormally thickened bile ducts using special
radiological tests. It is also important to exclude other diseases that can
mimic primary sclerosing cholangitis. These diseases include primary biliary cirrhosis (PBC), gallstones in
the bile ducts, bile duct cancers and strictures.
Blood tests
The blood level of alkaline phosphates is usually elevated in primary
sclerosing cholangitis. The blood
levels of other liver enzymes (AST and ALT) may also be mildly elevated. Except
in those patients with the autoimmune form of primary sclerosing cholangitis, the bilirubin usually is
normal but gradually increases as the disease progress.
Antimitochondrial
antibody (AMA), which is elevated in patients with PBC, is usually normal in
patients with primary sclerosing cholangitis.
Radiologic tests
Endoscopic retrograde cholangio-pancreatography
(ERCP) and magnetic
resonance cholangio-pancreatography (MRCP) are commonly performed to visualize
the intrahepatic and extrahepatic ducts. These ducts are typically normal in
appearance in patients with PBC, but in primary sclerosing cholangitis patients, these ducts have a beaded
appearance (multiple narrowings along the ducts with areas of widening in
between).
MRCP is noninvasive and safe. ERCP is more invasive and carries a 5%-6% chance
of causing an attack of acute pancreatitis. However, ERCP has the advantage of
obtaining cell samples (a process called brush cytology) from the bile ducts.
Brush cytology is not very accurate, but sometimes can help to diagnose
cholangiocarcinoma. Also, during ERCP, doctor can also insert balloons and
stents across major areas of narrowing (dominant strictures) to relieve
obstruction and treat infection.
Colonoscopy
Patients with primary sclerosing cholangitis have a high likelihood of also having ulcerative colitis,
and, as mentioned previously, patients with primary sclerosing cholangitis and ulcerative colitis have
higher risks of developing colon cancer. Thus,
colonoscopy is important to both
diagnose ulcerative colitis and for early detection of cancer or precancerous
conditions.
Next: How is primary sclerosing cholangitis treated? »
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