Diagnosis of Primary Sclerosing Cholangitis

How do doctors diagnose PSC?

Doctors diagnose primary sclerosing cholangitis (PSC) based on your medical and family history, a physical exam, and the results of medical tests.

Your doctor will ask you about your symptoms. He or she may also ask whether

• you have a history of inflammatory bowel disease, particularly ulcerative colitis
• one of your parents or siblings has PSC
• you have a history of autoimmune disease, such type 1 diabetes, celiac disease, and thyroid diseases

During a physical exam, your doctor may

• use a stethoscope to listen to sounds in your abdomen
• tap or press on specific areas of your abdomen
• look for symptoms of cirrhosis and liver failure
• check to see if your liver and spleen are larger than they should be
• check for tenderness or pain in your abdomen

Your doctor may also check for and ask about symptoms of a bile duct infection, which may include

• fever
• chills
• nausea
• vomiting
• yellowish eyes and skin, called jaundice

What medical tests do doctors use to diagnose PSC?

Blood tests

Liver function tests can show abnormal liver enzyme levels in your blood. Abnormal levels of certain liver enzymes may be a sign of damage to your liver or bile ducts. Blood tests can also show higher-than-normal levels of certain antibodies in the blood, which may be a sign of PSC. Another blood test, called a white blood cell (WBC) count, measures the number of WBCs in your blood. A high WBC count may be a sign of a bile duct infection.

Imaging tests

Your doctor may perform one or more of the following imaging tests of your liver and bile ducts:

• ultrasound
• computed tomography (CT) scans
• magnetic resonance imaging (MRI) scans
• magnetic resonance cholangiopancreatography (MRCP). MRCP uses an MRI machine to create pictures of the bile ducts and pancreatic ducts.
• endoscopic retrograde cholangiopancreatography (ERCP)
• percutaneous transhepatic cholangiography (PTC). PTC is an x-ray of the bile ducts. A special dye injected into the bile ducts lets a doctor see the bile ducts on the x-ray. PTC can show narrowing or blockage in the bile ducts.
• transient elastography, a special ultrasound that measures the stiffness of your liver

Imaging tests may help diagnose PSC by ruling out other causes of bile duct damage, such as autoimmune hepatitis and tumors.

Liver biopsy

In some cases, your doctor may perform a liver biopsy to

• confirm the diagnosis of PSC
• see whether the disease is advanced, as shown by the amount of liver scarring or cirrhosis
• rule out other diseases that may be causing your symptoms