Introduction:. It is the classic hepatobiliary manifestation of IBS. It is generally chronic progressive.
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PSC without colitis : colitis or immune activation in the gut might simply be too mild to be diagnosed by available techniques.
>50% need liver transplantation within 10–15 years of symptom development, as a result of reduced quality and quantity of life related to biliary obstruction, cholangitis, secondary biliary cirrhosis, & hepatobiliary malignant disease.
10–20% have dominant strictures—ie, stenosis of 1.5 mm or less in CBD or of 1 mm or less in the hepatic duct—many of whom have recurrent bacterial cholangitis.
Patients with dominant strictures have significantly worse survival than do those without dominant strictures.
Although most dominant strictures are benign, as much as 25% could be malignant.
Some patients present with cholelithiasis, gallbladder carcinoma, pancreatitis, or colorectal cancer.
PSC is an independent risk factor for CRC in IBD (*4 increased risk)& cumulative risk increases with disease duration (risk of CRC or dysplasia of 9%, 31%, 50% after 10, 20, 25 years, respectively, in patients with PSC a& UC vs2%, 5%, and 10% in those with UC only).
PSC associated with an increased risk of cholangiocarcinoma, GB cancer& CRC (in patients with colitis).
Advanced fibrosis or cirrhosis are at increased risk of HCC.
2/3 CC are diagnosed at the same time as, or within the first year after, diagnosis of PSC , yearly incidence of is 0.5–1.5%&lifetime risk is at least 10–15%.
CC can occur as an intrahepatic mass or a hilartumour.
Benign & malignant disease are difficult to distinguish&even the combination of tumour markers, various imaging modalities (MRI, CT, endoscopic ultrasonography) biliary brush cytology (including cytogenetic testing when available) cannot ensure early diagnosis.
High-grade dysplasia on brush cytology has high sensitivity, specificity&positive predictive value for diagnosis, and, when combined with carbohydrate antigen 19-9, sensitivity increases further.
Brush cytology necessitates ERCP or PTC which are associated with intrinsic risks.
EUS with FNA has greater sensitivity / specificity for the diagnosis of distal CC than do ERCP& brush cytology.
Fluorescence in-situ hybridisation, in which DNA probes are used to identify chromosomal changes& digital image analysis, are novel techniques to measure DNA proliferation that might im prove the diagnostic yield of cytology.
Other: cholangioscopy-guided biopsies& intra ductal E/S.
Urine bio markers by capillary electrophoresis mass spec trometry has generated a CC-specific peptide marker .