Primary Sclerosing Cholangitis (PSC)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)
    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Dr. Anand received MBBS degree from Medical College Amritsar, University of Punjab. He completed his Internal Medicine residency at the Postgraduate Institute of medical Education and Research, Chandigarh, India. He was trained in the field of Gastroenterology and obtained the DPhil degree. Dr. Anand is board-certified in Internal Medicine and Gastroenterology.

How is the diagnosis of primary sclerosing cholangitis made?

PSC may remain silent for several years before symptoms arise. In patients with inflammatory bowel disease, the health care professional should have a high suspicion of the diagnosis because of the relationship between PSC and ulcerative colitis.

Depending upon how far the disease has progressed and the effect on liver function, physical examination may reveal an enlarged liver, tenderness in the right upper quadrant beneath the ribs, and an enlarged spleen. The skin may be jaundiced or yellow and there can be evidence of scratching due to intense skin itching. In cirrhosis with end stage liver disease, there may be bruising of the skin, a swollen abdomen due to ascites or fluid caused by decreased protein production and decreased blood flow through the scarred liver, gastrointestinal bleeding, and mental confusion because of elevated ammonia levels in the bloodstream.

Blood tests are helpful in assessing the liver and potential blockages within the bile ducts. These may include a complete blood count, INR/PTT (that measures blood clotting and the ability of the liver to produce clotting factors), liver function studies including AST, and ALT to assess liver inflammation, alkaline phosphatase and bilirubin which measure the degree of bile blockage.

Imaging tests may include ultrasound to look at the liver structure and magnetic resonance cholangiogram, an MRI of the abdomen that can assess the bile duct structure of the liver.

If the diagnosis based on laboratory tests and imaging is still in doubt, a biopsy may be performed. A gastroenterologist or interventional radiologist will place a long, fine needle through the skin into the liver to obtain a piece of tissue. This is analyzed under a microscope by a pathologist to make the diagnosis.

Medically Reviewed by a Doctor on 11/18/2015

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