Primary Sclerosing Cholangitis

2007-12-28T02:13:00.000-08:00

Primary sclerosing cholangitis
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Classification & external resources
ICD-10
K 83.0
ICD-9
576.1
Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. A cholangitis is an inflammation of the bile ducts of the liver. Primary sclerosing cholangitis leads to Cholestasis (blockage of bile transport to the gut). Blockage of the bile duct leads to accumulation of bile, which damages the liver, leading to jaundice and eventually causes liver failure.

Signs and symptoms

Tiredness (a non-specific symptom often present in liver disease)
Severe jaundice with intense itching
Malabsorption (especially of fat) and steatorrhea, leading to decreased levels of the fat-soluble vitamins, A, D, E and K.
Signs of Cirrhosis
Ascending cholangitis, or infection of the bile duct.

Diagnosis
The diagnosis is by imaging of the bile duct, usually in the setting of Endoscopic Retrograde Cholangiopancreatography (ERCP, endoscopy of the bile duct and The Pancreas ), which shows characteristic changes ("beading") of the bile ducts. Another option is Magnetic Resonance Cholangiopancreatography (MRCP), where Magnetic Resonance Imaging is used to visualise the biliary tract.

Other tests often done are a Complete Blood Count, liver enzymes, bilirubin levels (usually grossly elevated), renal function, electrolytes (see Comprehensive Metabolic Panel (CMP)). Fecal fat determination is occasionally ordered when the symptoms of malabsorption are prominent.

The differential diagnosis can include Primary Biliary Cirrhosis PBC, drug induced Cholestasis, cholangiocarcinoma, and HIV-associated cholangiopathy.

Etiology
The cause(s) for PSC are unknown. It is often considered to be an autoimmune disorder. PSC is associated with Ulcerative Colitis. It is assumed that these diseases share a common cause.
Ulcerative colitis is a systemic disease that affects many areas of the body. PSC is often listed as a manifestation of ulcerative colitis outside the colon. PSC differs from these manifestations in that, unlike most other manifestations, PSC continues in spite of surgical removal of the colon.[1] This suggests that, while the cause of ulcerative colitis, and most of its manifestations, is in the colon, the cause of PSC is located outside the colon.

Pathophysiology
Bile ducts, both intra- and extrahepatically (inside the liver and outside), are inflamed and develop scarring, obstructing the flow of bile. As bile assists in the enteric breakdown and absorption of fat, the absence of bile leads to fat malabsorption. The bile accumulates in the duct, leading to liver cell damage and liver failure.

Epidemiology
It is more prevalent in men than in women. The disease normally starts from age 30 to 60. It can however also start with children. PSC progresses slowly, so the disease can be active for a long time before it is noticed or diagnosed.

Screening
PSC is associated with Cholangiocarcinoma: Bile Duct Cancer , which are tumors involving the biliary tree. Screening for cholangiocarcinoma in patients with PSC is encouraged, but there is no general consensus on the modality and interval of choice.

Therapy
Standard treatment includes ursodiol, a bile acid naturally produced by the liver, which has been shown to lower elevated liver enzyme numbers in people with PSC, but has not yet been proven effective at prolonging the life of the liver. Treatment also includes medication to relieve itching (antipruritics) and bile acid sequesterants (cholestyramine), antibiotics to treat infections, and vitamin supplements, as people with PSC are often deficient in vitamin A, vitamin D, and vitamin K.

In some cases, ERCP, which may involve stenting of the common bile duct, may be necessary in order to open major blockages (dominant strictures).
Liver transplantation (including live transplants whereby a portion of a living donor is given to the recipient) is an option if the liver begins to fail.

External links
Additional Literature about PSC
Link to PSC Partners, a nonprofit foundation for PSC patients and caregivers
PSC Trust is a medical research charity
Liver Families, a pediatric liver support group
The Morgan Foundation for the Study of PSC
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vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - Irritable bowel syndrome (IBS)other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis)
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Accessorydigestive
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Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis)Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis)
Other/general
Appendicitis - Peritonitis (Spontaneous bacterial peritonitis)
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postprocedural: Gastric dumping syndrome - Postcholecystectomy syndromebleeding: Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower)
See also congenital
Retrieved from "http://en.wikipedia.org/wiki/Primary_sclerosing_cholangitis"
Categories: Gastroenterology Autoimmune diseases Hepatology Inflammations