Primary Sclerosing Cholangitis Follow-up

  • Author: Vikas Khurana, MD, FACP, FACG; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 6, 2012
 

Further Inpatient Care

  • Further inpatient care is dictated by the admitting diagnosis and complications and may involve any or all of the previously discussed treatment options.
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Further Outpatient Care

  • Further outpatient care is dictated by the stage and degree of progression of the disease. It involves care by a gastroenterologist, who must monitor the patient's condition with frequent laboratory tests and maintain vigilance for the many complications of PSC. Suitability for liver transplantation should be determined expeditiously and, if appropriate, offered to the patient.
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Deterrence/Prevention

  • PSC is a progressive disease, and no preventive strategies have been proven effective. Stopping smoking and/or drinking may decrease or delay the chances of developing cholangiocarcinoma.
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Complications

  • Chronic cholestasis leads to steatorrhea, fat-soluble vitamin (A, D, E, and K) deficiency, metabolic bone disease with osteoporosis, and calorie loss with resultant weight loss.
  • Cholangitis and cholelithiasis occur more frequently in patients with PSC.
  • Cholangiocarcinoma reportedly occurs in association with PSC in 6-30% of patients and in up to 30-40% of patients with PSC on autopsy. The development of cholangiocarcinoma remains unpredictable in any given patient, and no reliable serological tumor markers have been identified.
  • Secondary biliary cirrhosis due to chronic cholestasis occurs in patients with PSC. Portal hypertension with variceal bleeding, ascites, and liver failure then ensue.
  • Dominant biliary strictures can be identified in about 20% of patients with PSC and must be differentiated from cholangiocarcinoma. Strictures cause cholestasis with jaundice and pruritus and may also result in cholangitis.
  • The risk of colon cancer is increased for patients with both ulcerative colitis and PSC versus those with only ulcerative colitis.
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Prognosis

  • PSC is a progressive disorder that ultimately leads to hepatic failure. Median survival time without liver transplantation is about 12 years. Survival prospects are more dismal for those who are symptomatic at diagnosis. The following variables influence prognosis:
    • Revised Mayo Clinic model
      • Age
      • Serum bilirubin, albumin, and aspartate aminotransferase levels
      • Variceal bleeding history
    • Child-Turcotte-Pugh scale
      • Grade of encephalopathy
      • Presence or absence of ascites
      • Serum albumin level
      • Prothrombin time
      • Bilirubin level
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Patient Education

  • Educate patients regarding the natural course of the disease, expected complications, and treatment strategies, including liver transplantation.
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Contributor Information and Disclosures
Author

Vikas Khurana, MD, FACP, FACG  Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Graduate Hospital, Gastroenterology Associates, PC

Disclosure: Nothing to disclose.

Coauthor(s)

Tejinder Singh, MD  Lead Physician, Section of Emergency Services, Overton Brooks Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Praveen K Roy, MD, AGAF  Gastroenterologist, Ochsner Clinic Foundation; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute; Editor-in-Chief, The Internet Journal of Gasteroenterology; Editorial Board, Signal Transduction Insights; Editorial Board, The Internet Journal of Epidemiology; Editorial Board, Gastrointestinal Endoscopy Review Letter

Praveen K Roy, MD, AGAF is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

David Greenwald, MD  Associate Professor of Clinical Medicine, Fellowship Program Director, Department of Medicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine

David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Simmy Bank, MD  Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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