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Sclerosing cholangitis

Primary sclerosing cholangitis; PSC

 

Sclerosing cholangitis refers to swelling (inflammation), scarring, and destruction of the bile ducts inside and outside of the liver.

Causes

 

The cause of this condition is usually unknown.

The disease may be seen in people who have:

  • Autoimmune disorders
  • Chronic pancreatitis (inflamed pancreas)
  • Inflammatory bowel disease ( Crohn disease and ulcerative colitis )
  • Sarcoidosis (a disease that causes inflammation in various parts of the body)

Genetic factors may also be responsible. Sclerosing cholangitis occurs more often in men than women. This disorder is rare in children.

Sclerosing cholangitis may also be caused by:

  • Choledocholithiasis (gallstones in the bile duct)
  • Infections in the liver, gallbladder, and bile ducts

 

Symptoms

 

The first symptoms are usually:

  • Fatigue
  • Itching
  • Yellowing of the skin and eyes (jaundice)

However, some people have no symptoms.

Other symptoms may include:

  • Enlarged liver
  • Enlarged spleen
  • Loss of appetite and weight loss
  • Repeat episodes of cholangitis

 

Exams and Tests

 

Even though some people do not have symptoms, blood tests shows that they have abnormal liver function. Your health care provider will look for:

  • Diseases that cause similar problems
  • Diseases that often occur with this condition (especially inflammatory bowel disease)
  • Gallstones

Tests that show cholangitis include:

  • Abdominal CT scan
  • Abdominal ultrasound
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Liver biopsy
  • Magnetic resonance cholangiopancreatography (MRCP)
  • Percutaneous transhepatic cholangiogram ( PTC )

Blood tests include liver enzymes ( liver function tests ).

 

Treatment

 

Medicines that may be used include:

  • Cholestyramine (such as Prevalite) to treat itching Ursodeoxycholic acid (ursodiol) to improve liver function
  • Fat-soluble vitamins (D, E, A, K) to replace what is lost from the disease itself
  • Antibiotics to treat infections in the bile ducts
  • Medicines to quiet the immune system (such as prednisone, azathioprine, cyclosporine, or methotrexate)

These surgical procedures may be done:

  • Inserting a long, thin tube with a balloon at the end to open up narrowing ( endoscopic balloon dilation of strictures)
  • Placement of a drain or tube for major narrowing (strictures) of bile ducts
  • Proctocolectomy (removal of colon and rectum, for those who have both ulcerative colitis and sclerosing cholangitis)
  • Liver transplant

 

Outlook (Prognosis)

 

How well people do varies. The disease tends to get worse over time, and sometimes people develop:

  • Ascites (buildup of fluid in the space between the lining of the abdomen and abdominal organs) and varices (enlarged veins)
  • Biliary cirrhosis (inflammation of the bile ducts)
  • Liver failure
  • Persistent jaundice

Some people develop infections of the bile ducts that keep returning.

People with this condition have an increased risk of developing cancer of the bile ducts (cholangiocarcinoma). They should be checked regularly with a liver imaging test and blood tests. People who also have inflammatory bowel disease may have an increased risk of developing cancer of the colon or rectum and should have periodic colonoscopy.

 

Possible Complications

 

Complications may include:

  • Bleeding esophageal varices
  • Cancer in the bile ducts ( cholangiocarcinoma )
  • Cirrhosis and liver failure
  • Infection of the biliary system (cholangitis)
  • Narrowing of the bile ducts
  • Vitamin deficiencies

 

 

Open References

References

Gordon FD. Primary sclerosing cholangitis. Surg Clin North Am . 2008;88:1385-407.

Ross AS, Kowdley KV. Sclerosing cholangitis and recurrent pyogenic cholangitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease . 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 68.

Sabbaghian S, Ahrendt SA. Primary Sclerosing Cholangitis. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy . 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:409-13.

Wang C, Pressman A. Primary Sclerosing Cholangitis. In: Ferri FF, ed. Ferri's Clinical Advisor 2015 . 1st ed. Philadelphia, PA: Elsevier Mosby; 2015:section I.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Bile pathway

    Bile pathway - illustration

    The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

    Bile pathway

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Bile pathway

      Bile pathway - illustration

      The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

      Bile pathway

      illustration

    A Closer Look

     

      Tests for Sclerosing cholangitis

       
         

        Review Date: 4/20/2015

        Reviewed By: Subodh K. Lal, MD, Gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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