hepatic and biliary disorders
Primary Sclerosing Cholangitis (PSC)
Key Points
Most (80%) patients with PSC have IBD, usually ulcerative colitis, and many have autoantibodies. Suspect PSC if patients, particularly those with inflammatory bowel disease, have an unexplained cholestatic pattern of abnormalities in liver tests. Exclude extrahepatic biliary obstruction by ultrasonography, then do MRCP (or, as a second choice, ERCP). Monitor patients with periodic liver testing, screen regularly for gallbladder cancer and cholangiocarcinoma, and treat symptoms and complications (eg, ERCP to evaluate and treat dominant strictures). Consider liver transplantation if recurrent cholangitis or complications of liver failure develop. 