Primary Sclerosing Cholangitis (PSC)

What PSC is

Primary sclerosing cholangitis, or PSC, is a chronic disease that scars and narrows the bile ducts inside and outside the liver. Bile flow can slow, and the liver can scar over time.

It often occurs with inflammatory bowel disease, especially ulcerative colitis. The cause is not known. It is not an infection, and it is not caused by alcohol.

Symptoms and complications

Some people have no symptoms. When changes do appear, a person may notice:

• Tiredness
• Itching
• Pain under the right ribs
• Yellow skin or eyes
• Fever and chills
• Swelling of the belly or legs
• Confusion or unusual sleepiness

Fever with chills and yellow skin can be a bile-duct infection. Contact the office the same day, or go to an emergency department if you cannot reach the clinic. Vomiting blood, or black stools, needs emergency care. If you have urgent symptoms, call 911 or go to an emergency department.

Diagnosis and tests

Blood tests can show a bile-duct problem. They do not prove PSC by themselves.

The usual scan is an MRI of the bile ducts. Ultrasound may be used as well. A biopsy is not required for most people. Because PSC often occurs with bowel inflammation, a clinician may also arrange a bowel exam.

Your family doctor arranges imaging. A clinician reads the tests together, and no single result sets a treatment plan on its own.

Treatment and management

There is no single medicine that cures PSC. Care focuses on blood tests and imaging, treatment of itching and other symptoms, and prompt care of bile-duct infections.

The clinician also watches for blocked ducts and for cancers related to PSC. Monitoring does not mean those problems will occur.

If the liver is severely damaged, a clinician may discuss liver transplant. This page does not say who is eligible.