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Diagnosis of PSC
See your doctor when you have severe, persistent, and unexplained itching or fatigue that affects your daily life. Also, you should talk with your doctor if you have itching, fatigue, jaundice, or any other symptoms and IBD.
Many cases discover PSC accidentally during routine tests or investigating another problem due to the abnormal liver function tests. But, the others see the doctor due to complaints.
An efficient diagnosis starts with good history taking. Your doctor will hear your complaint, ask you about how they progress over time, and ask you if you have other symptoms. Also, he will ask you if you have other diseases, especially IBD. Then, he will ask about your family history regarding liver diseases, IBD, and autoimmune diseases.
The 2nd step is the physical examination, which reveals the signs of liver affection, such as jaundice, ascites, and edema.
After history taking and physical examination, your doctor will suspect that your problem is in the liver and bile duct that may be PSC. Thus, he will start investigations to confirm his initial diagnosis.
Investigations for PSC include:
Liver functions tests
They are blood tests that measure the liver enzymes and give an idea about the liver condition. If they are abnormal during routine investigations, your doctor will pay attention to your liver. In PSC, these tests will show elevated alkaline phosphatase.
MRCP (Magnetic Resonance CholangioPancreatography)
This imaging technique uses magnetic resonance to make images for your liver and bile ducts. It is the 1st choice to diagnose PSC because it is non-invasive, safe, and painless.
ERCP (Endoscopic Retrograde CholangioPancreatography)
Your doctor will give you a sedative, insert an endoscope through your mouth to reach the intestine, and inject a dye into your bile ducts. Then, he will take X-ray pictures of your bile ducts.
Your doctor can also use this technique for therapeutic purposes. It is the choice for diagnosis when MRCP is impossible, such as if your body contains metal implants. Also, your doctor will do it if the symptoms persist despite normal MRCP.
Liver biopsy
Your doctor will take a biopsy from your liver if he can’t reach a diagnosis with the previous techniques. It also reveals the extent and severity of liver damage.
