CaseStudy-05112016 - 2

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5 Nov 2016 - General

A young gentleman, with background history of Inflammatory bowel disease - Ulcerative colitis, on 5-ASA, attended regular clinic for follow up. He has history of ulcerative colitis for the last 5 years. Patient was asymptomatic, with normal bowel motion, with no PR bleeding, no diarrhoea, no weight loss and having good appetite. He was in clinical remission with regards to his ulcerative colitis. His blood tests was taken by his GP 1 week prior to the clinic, and you noted that there was some derangement of his liver function test, predominantly some elevation of the ALP and GGT (double the normal value), with normal bilirubin. Patient was not taking any other medications recently. What is your impression ?? What investigations (any other blood test or any scan/imaging) that you may consider to orde for this patient ??

Clinical practice guidelines in diagnosing PSC recommends that MRCP is preferred over endoscopic retrograde cholangiopancreatography (ERCP) to establish a diagnosis of PSC. It also states that liver biopsy is not necessary to make a diagnosis in patients with suspected PSC based on diagnostic cholangiographic
findings. Furthermore, Liver biopsy is only recommended to make a diagnosis in patients with suspected small duct PSC or to exclude other conditions such as suspected overlap with autoi...
 (Total 91 words)
Yes Md Shamim Reza , Primary sclerosing cholangitis (PSC) will be the most likely diagnosis, and it is associated with ulcerative colitis. Ulcerative colitis are present in around 70% of patients with primary sclerosing cholangitis. Serum auto-antibodies and serum immunoglobulin level should be checked. Magnetic resonance cholangio-pacreatography (MRCP) will be useful in diagnosis primary sclerosing cholangitis. ...
 (Total 113 words)
In my opinion, it is a probable case of Primary sclerosing cholangitis.
Ulcerative colitis is associated with primary sclerosing cholangitis and usually a raised ALP is found incidentally during the coarse of treatment.
Alternatively, cholangiocarcinoma may be a differential diagnosis which is also associated with ulcerative colitis.
The key investigation is now MRCP which will probably be diagnostic. ERCP may be required later for intervention. Liver function tests may show some ot...
 (Total 94 words)