Primary sclerosing cholangitis is another diseases which induces alkaline phosphatase. This is a cholestatic disease whose etiology is unknown. This disease differs from primary biliary cirrhosis in that the large bile ducts, the extra hepatic biliary tree are affected. Scarring and development of cancers in the bile ducts are not uncommon.
Diagnosis of PSC
Liver function tests, CT scan and ultrasound may be used to diagnose PSC. An ERCP is the diagnostic tool of choice. This allows complete visualization of the extra hepatic biliary tree as well as therapeutic intervention. A major complication of primary sclerosing cholangitis is stricture formation. These strictures usually occur in the larger bile ducts. They may be dilated at the time of ERCP. When these strictures become small, bile becomes infected. In this case, a cholangitis occurs.
Common symptoms at the time of diagnosis are:
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Fatigue |
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Pruritis |
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Jaundice |
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Fever |
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Weight loss |
Physical exam changes in PSC are:
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Enlarged liver |
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Jaundice |
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Enlarged spleen |
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Darkened skin |
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Xanthelasma |
These diseases have been associated with cholangitis. These are:
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Ulcerative colitis |
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Crohn's disease |
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Celiac sprue |
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Sarcoidosis |
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Chronic pancreatitis |
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Rheumatoid arthritis |
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Sjogren's disease |
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Thyroiditis |
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Autoimmune chronic hepatitis |
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Systemic lupus erythematous |
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Bronchiectasis |
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Auto immune hemolytic anemias |
Therapy
Patients with primary sclerosing cholangitis have problems associated with strictures in the large bile ducts. Thus, therapy is directed at eliminating and managing strictures of the bile ducts. In addition, many mediations have been tested to treat this disease. Medical therapy for PSC has not been helpful. The most commonly used medication is ursochenodeoxycholic acid. This medication may be of some benefit. Since it has minimal side effects (mild diarrhea is the most common), it is commonly used for patients with PSC.
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Related Links
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