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PBC and PSC

PSC: Diagnosis

liver biopsy

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“onion skin” fibrosis is most common (50% patients)

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“obliterative fibrous cholangitis” is pathognomonic (10%)

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most findings can be confused with chronic hepatitis or auto-immune hepatitis

imaging studies

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non-specific findings variably present

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dilated intra-hepatic ducts may be seen

cholangiography

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ERCP considered the “gold standard”

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MRCP reported to have PPV of 90% and sens/spec of ~85% compared to ERCP

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75% will have strictures at the bifurcation

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