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possible psc liver disease
I am at 35 year old female. I started not feeling well in Feb. I had chronic nausea and heartburn. Dr. Put me in nexium . Ultrasound showed a Gallstone. Had surgery and still did not feel better. GI Dr. Did an endoscopy that showed gastritis. Found out I am b12 and vitamin d deficient. When endocronologist did blood work my liver enzymes were slightly elevated. My regular Dr. Repeated the test about a month later and they were still elevated and even more. ast was 45 and alt was 83. Everything else was normal. GI Dr. Ran antibody tests. The only one that came out positive was the asks and it was 1:80. Now he is doing a liver biopsy in 2 weeks to determine if I have psc liver disease. Do you think I have s very high chance of having it based on these numbers. I am a need right now. I csnnot sleep and I am physically making myself sick thinking about it all day everyday. Any opinion would be greatly appreciated....
I'll tell you what I know.
Women are half as likely to have PSC than men.
I don't know what "asks" is. I do know that auto-antibodies are usually present. I found this at Wikipedia:
"Diagnosis
The diagnosis is by imaging of the bile duct, usually in the setting of endoscopic retrograde cholangiopancreatography (ERCP, endoscopy of the bile duct and pancreas), which shows "beading" (both strictures and dilation) of the intrahepatic and extrahepatic bile ducts. Another option is magnetic resonance cholangiopancreatography (MRCP), where magnetic resonance imaging is used to visualise the biliary tract.
Most patients with PSC have evidence of autoantibodies. Approximately 80% of patients have perinuclear anti-neutrophil cytoplasmic antibodies, also called p-ANCA; however, this finding is not specific for PSC. Antinuclear antibodies and anti-smooth muscle antibody are found in 20%-50% of PSC patients and, likewise, are not specific for the disease.[1]
Other tests often done are a full blood count, liver enzymes, bilirubin levels (usually grossly elevated), renal function, electrolytes. Fecal fat determination is occasionally ordered when the symptoms of malabsorption are prominent.
The differential diagnosis can include primary biliary cirrhosis, drug induced cholestasis, cholangiocarcinoma, and HIV-associated cholangiopath."
See: http://en.wikipedia.org/wiki/Primary_sclerosing_cholangitis
Most patients with PSC (80%) also have ulcerative colitis.
I have to question the appropriateness of a liver biopsy if PSC is the suspected disease. From what I know and according to the sources I have a biopsy isn't usually determinative of PSC. Imaging studies are usually done first.
"Cholangiography
Better visualisation of the bile ducts is achieved with magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP).
The characteristic cholangiographic features of PSC are minor ductal irregularities, decreased branching or narrowing of the intrahepatic biliary tree, and multi-focal stricturing of the intra- and extrahepatic bile ducts with areas of both normal calibre and dilated bile ducts, resulting in a 'beaded' appearance. However, decreased branching or 'diminution' of the intrahepatic biliary tree may also be present in patients with cirrhosis of any cause. [32] View imageView imageView image
Both ERCP and MRCP can establish a diagnosis and provide information on the distribution and extent of disease.
MRCP is non-invasive with comparable performance to ERCP. It is a reasonable first imaging study for asymptomatic patients with little to no cholestasis who are unlikely to require therapeutic intervention. When MRCP is non-diagnostic or when the need for a therapeutic intervention is anticipated (e.g., high suspicion of dominant stricture or cholangiocarcinoma), ERCP is indicated. [33] [34] [25]
ERCP has been considered the definitive test for diagnosing PSC. However, the invasive nature has associated risks, including pancreatitis, bleeding, cholangitis, and perforation. [25] [35]
ERCP is important for diagnostic and therapeutic interventions that cannot be performed with MRCP (e.g., brush cytology to evaluate for co-existing malignancy, extraction of bile duct stones, and dilation of prominent bile duct strictures). [25] [35]"
Histology
Liver biopsy may support the diagnosis of PSC but is rarely diagnostic and is not necessary if clinical, laboratory, and radiographic findings already suggest PSC. There is evidence to suggest that liver biopsy in patients with cholangiographically diagnosed PSC adds new information or affects management in only 1.3% of patients. [39] However, liver biopsy may be necessary and is recommended to diagnose small-duct PSC (characterised by laboratory and histological findings typical for PSC but with normal cholangiogram) or to evaluate for alternative or overlapping disorders. Liver biopsy is also useful for staging disease (primarily for detecting cirrhosis, if not clinically apparent). [25]
See:
http://bestpractice.bmj.com/best-practice/monograph/847/diagnosis/step-by-step.html
Another relevant link is:
http://www.gastrotraining.com/hepatology/primary-sclerosing-cholangitis/primary-sclerosing-cholangitis-psc
I should have started by telling you that I am not a doctor or in the medical profession in any capacity so my opinion isn't worth much if anything.
Good luck,
Mike
Women are half as likely to have PSC than men.
I don't know what "asks" is. I do know that auto-antibodies are usually present. I found this at Wikipedia:
"Diagnosis
The diagnosis is by imaging of the bile duct, usually in the setting of endoscopic retrograde cholangiopancreatography (ERCP, endoscopy of the bile duct and pancreas), which shows "beading" (both strictures and dilation) of the intrahepatic and extrahepatic bile ducts. Another option is magnetic resonance cholangiopancreatography (MRCP), where magnetic resonance imaging is used to visualise the biliary tract.
Most patients with PSC have evidence of autoantibodies. Approximately 80% of patients have perinuclear anti-neutrophil cytoplasmic antibodies, also called p-ANCA; however, this finding is not specific for PSC. Antinuclear antibodies and anti-smooth muscle antibody are found in 20%-50% of PSC patients and, likewise, are not specific for the disease.[1]
Other tests often done are a full blood count, liver enzymes, bilirubin levels (usually grossly elevated), renal function, electrolytes. Fecal fat determination is occasionally ordered when the symptoms of malabsorption are prominent.
The differential diagnosis can include primary biliary cirrhosis, drug induced cholestasis, cholangiocarcinoma, and HIV-associated cholangiopath."
See: http://en.wikipedia.org/wiki/Primary_sclerosing_cholangitis
Most patients with PSC (80%) also have ulcerative colitis.
I have to question the appropriateness of a liver biopsy if PSC is the suspected disease. From what I know and according to the sources I have a biopsy isn't usually determinative of PSC. Imaging studies are usually done first.
"Cholangiography
Better visualisation of the bile ducts is achieved with magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP).
The characteristic cholangiographic features of PSC are minor ductal irregularities, decreased branching or narrowing of the intrahepatic biliary tree, and multi-focal stricturing of the intra- and extrahepatic bile ducts with areas of both normal calibre and dilated bile ducts, resulting in a 'beaded' appearance. However, decreased branching or 'diminution' of the intrahepatic biliary tree may also be present in patients with cirrhosis of any cause. [32] View imageView imageView image
Both ERCP and MRCP can establish a diagnosis and provide information on the distribution and extent of disease.
MRCP is non-invasive with comparable performance to ERCP. It is a reasonable first imaging study for asymptomatic patients with little to no cholestasis who are unlikely to require therapeutic intervention. When MRCP is non-diagnostic or when the need for a therapeutic intervention is anticipated (e.g., high suspicion of dominant stricture or cholangiocarcinoma), ERCP is indicated. [33] [34] [25]
ERCP has been considered the definitive test for diagnosing PSC. However, the invasive nature has associated risks, including pancreatitis, bleeding, cholangitis, and perforation. [25] [35]
ERCP is important for diagnostic and therapeutic interventions that cannot be performed with MRCP (e.g., brush cytology to evaluate for co-existing malignancy, extraction of bile duct stones, and dilation of prominent bile duct strictures). [25] [35]"
Histology
Liver biopsy may support the diagnosis of PSC but is rarely diagnostic and is not necessary if clinical, laboratory, and radiographic findings already suggest PSC. There is evidence to suggest that liver biopsy in patients with cholangiographically diagnosed PSC adds new information or affects management in only 1.3% of patients. [39] However, liver biopsy may be necessary and is recommended to diagnose small-duct PSC (characterised by laboratory and histological findings typical for PSC but with normal cholangiogram) or to evaluate for alternative or overlapping disorders. Liver biopsy is also useful for staging disease (primarily for detecting cirrhosis, if not clinically apparent). [25]
See:
http://bestpractice.bmj.com/best-practice/monograph/847/diagnosis/step-by-step.html
Another relevant link is:
http://www.gastrotraining.com/hepatology/primary-sclerosing-cholangitis/primary-sclerosing-cholangitis-psc
I should have started by telling you that I am not a doctor or in the medical profession in any capacity so my opinion isn't worth much if anything.
Good luck,
Mike
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