Primary Sclerosing Cholangitis (PSC) (cont.)

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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 collected because of decreased protein production by the 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, ALT, alkaline phosphatase and bilirubin to assess liver inflammation.

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 4/23/2014

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