What's the most likely diagnosis?
- 36 year-old undergoing ERCP for RUQ pain
Image from Endoscopic Retrograde Cholangio-pancreaticography
(ERCP)
- Pancreatic carcinoma
- Caroli's disease
- Choledocal cyst
- Biliary calculus
- Primary sclerosing cholangitis
Additional Image - Additional image from ERCP
Additional Image
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Image from ERCP
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Answer:
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5. Primary sclerosing cholangitis
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Primary Sclerosing Cholangitis (PSC)
General Considerations
- Inflammation, destruction and fibrosis of intrahepatic and extrahepatic bile ducts
- Unknown etiology but thought to be auto-immune
- A major cause of liver transplants in United States
- Majority occur in association with inflammatory bowel disease (IBD)
- Most often ulcerative colitis (UC)
- 5% of all patients with UC have PSC
- 75% of all patients with PSC will have UC
- Most often between 30-60 years of age with a mean of 40
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