Primary sclerosing cholangitis - Revision history

Mitchell: /* Images */ Added a case

2016-09-11T21:21:43Z

Images: Added a case

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	*[http://www.onmedica.com/getresource.aspx?resourceid=e398a3f2-e030-40e6-823b-2e8e2cbbe4bb PSC (onmedica.com)].<ref>URL: [http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc]. Accessed on: 1 January 2011.</ref>		*[http://www.onmedica.com/getresource.aspx?resourceid=e398a3f2-e030-40e6-823b-2e8e2cbbe4bb PSC (onmedica.com)].<ref>URL: [http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc]. Accessed on: 1 January 2011.</ref>
	*[http://www.nature.com/nrgastro/journal/v7/n11/fig_tab/nrgastro.2010.155_F2.html PSC (nature.com)].<ref>{{Cite journal \| last1 = Mendes \| first1 = F. \| last2 = Lindor \| first2 = KD. \| title = Primary sclerosing cholangitis: overview and update. \| journal = Nat Rev Gastroenterol Hepatol \| volume = 7 \| issue = 11 \| pages = 611-9 \| month = Nov \| year = 2010 \| doi = 10.1038/nrgastro.2010.155 \| PMID = 20938459 }}</ref>		*[http://www.nature.com/nrgastro/journal/v7/n11/fig_tab/nrgastro.2010.155_F2.html PSC (nature.com)].<ref>{{Cite journal \| last1 = Mendes \| first1 = F. \| last2 = Lindor \| first2 = KD. \| title = Primary sclerosing cholangitis: overview and update. \| journal = Nat Rev Gastroenterol Hepatol \| volume = 7 \| issue = 11 \| pages = 611-9 \| month = Nov \| year = 2010 \| doi = 10.1038/nrgastro.2010.155 \| PMID = 20938459 }}</ref>

			{\|
			[[File:1 PSC 1 680x512px.tif\| Primary sclerosing cholangitis in patient with history of ulcerative colitis.]]
			[[File:2 PSC 1 680x512px.tif\| Primary sclerosing cholangitis in patient with history of ulcerative colitis.]]
			<br>
			[[File:3 PSC 1 680x512px.tif\| Primary sclerosing cholangitis in patient with history of ulcerative colitis.]]
			[[File:4 PSC 1 680x512px.tif\| Primary sclerosing cholangitis in patient with history of ulcerative colitis.]]
			<br>
			[[File:5 PSC 1 680x512px.tif\| Primary sclerosing cholangitis in patient with history of ulcerative colitis.]]
			[[File:6 PSC 1 680x512px.tif\| Primary sclerosing cholangitis in patient with history of ulcerative colitis.]]
			\|}
			<br>Primary sclerosing cholangitis in patient with history of ulcerative colitis. <br>Low power shows inflamed bands [green arrows] and a rare scar at the edge of a triad [black arrow] (Row 1 Left 40X). A triad with a characteristic periductal fibrosis [black arrows] is seen (Row 1 Right 200X). Reticulin shows the space about the duct [green arrows], as well as some foci of piecemeal necrosis [blue arrows] (Row 2 Left 200X). Trichrome shows fibrous bridges [black arrows] (Row 2 Right 200X). Damage to bile ducts is seen by peripheral proliferated bile ductules [green arrows] with neutrophils [blue arrows] (Row 3 Left 400X). Also seen is a small periportal bile infarct with necrotic hepatocyte nuclei [black arrows] (Row 3 Right 400X).

	==See also==		==See also==

Michael: /* Images */

2015-04-06T02:38:24Z

Images

← Older revision		Revision as of 02:38, 6 April 2015
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	*[http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Primary_Sclerosing_Cholangitis-2.jpg PSC (trialx.com)].<ref>URL: [http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/ http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/]. Accessed on: 1 January 2012.</ref>		*[http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Primary_Sclerosing_Cholangitis-2.jpg PSC (trialx.com)].<ref>URL: [http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/ http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/]. Accessed on: 1 January 2012.</ref>
	*[http://www.onmedica.com/getresource.aspx?resourceid=e398a3f2-e030-40e6-823b-2e8e2cbbe4bb PSC (onmedica.com)].<ref>URL: [http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc]. Accessed on: 1 January 2011.</ref>		*[http://www.onmedica.com/getresource.aspx?resourceid=e398a3f2-e030-40e6-823b-2e8e2cbbe4bb PSC (onmedica.com)].<ref>URL: [http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc]. Accessed on: 1 January 2011.</ref>
			*[http://www.nature.com/nrgastro/journal/v7/n11/fig_tab/nrgastro.2010.155_F2.html PSC (nature.com)].<ref>{{Cite journal \| last1 = Mendes \| first1 = F. \| last2 = Lindor \| first2 = KD. \| title = Primary sclerosing cholangitis: overview and update. \| journal = Nat Rev Gastroenterol Hepatol \| volume = 7 \| issue = 11 \| pages = 611-9 \| month = Nov \| year = 2010 \| doi = 10.1038/nrgastro.2010.155 \| PMID = 20938459 }}</ref>

	==See also==		==See also==

Michael: /* Microscopic */

2015-03-24T01:06:37Z

Microscopic

← Older revision		Revision as of 01:06, 24 March 2015
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	DDx:		DDx:
	*IgG4-associated cholangitis - see [[IgG4-related ~~systemic~~ disease]].<ref name=pmid19633647>{{Cite journal \| last1 = Deshpande \| first1 = V. \| last2 = Sainani \| first2 = NI. \| last3 = Chung \| first3 = RT. \| last4 = Pratt \| first4 = DS. \| last5 = Mentha \| first5 = G. \| last6 = Rubbia-Brandt \| first6 = L. \| last7 = Lauwers \| first7 = GY. \| title = IgG4-associated cholangitis: a comparative histological and immunophenotypic study with primary sclerosing cholangitis on liver biopsy material. \| journal = Mod Pathol \| volume = 22 \| issue = 10 \| pages = 1287-95 \| month = Oct \| year = 2009 \| doi = 10.1038/modpathol.2009.94 \| PMID = 19633647 }}</ref>		*IgG4-associated cholangitis - see [[IgG4-related disease]].<ref name=pmid19633647>{{Cite journal \| last1 = Deshpande \| first1 = V. \| last2 = Sainani \| first2 = NI. \| last3 = Chung \| first3 = RT. \| last4 = Pratt \| first4 = DS. \| last5 = Mentha \| first5 = G. \| last6 = Rubbia-Brandt \| first6 = L. \| last7 = Lauwers \| first7 = GY. \| title = IgG4-associated cholangitis: a comparative histological and immunophenotypic study with primary sclerosing cholangitis on liver biopsy material. \| journal = Mod Pathol \| volume = 22 \| issue = 10 \| pages = 1287-95 \| month = Oct \| year = 2009 \| doi = 10.1038/modpathol.2009.94 \| PMID = 19633647 }}</ref>
	*Others.		*Others.

Michael: /* Microscopic */

2015-03-24T01:04:26Z

Microscopic

← Older revision		Revision as of 01:04, 24 March 2015
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	DDx:		DDx:
	*IgG4-associated cholangitis.<ref>{{Cite journal \| last1 = Deshpande \| first1 = V. \| last2 = Sainani \| first2 = NI. \| last3 = Chung \| first3 = RT. \| last4 = Pratt \| first4 = DS. \| last5 = Mentha \| first5 = G. \| last6 = Rubbia-Brandt \| first6 = L. \| last7 = Lauwers \| first7 = GY. \| title = IgG4-associated cholangitis: a comparative histological and immunophenotypic study with primary sclerosing cholangitis on liver biopsy material. \| journal = Mod Pathol \| volume = 22 \| issue = 10 \| pages = 1287-95 \| month = Oct \| year = 2009 \| doi = 10.1038/modpathol.2009.94 \| PMID = 19633647 }}</ref>		*IgG4-associated cholangitis - see [[IgG4-related systemic disease]].<ref name=pmid19633647>{{Cite journal \| last1 = Deshpande \| first1 = V. \| last2 = Sainani \| first2 = NI. \| last3 = Chung \| first3 = RT. \| last4 = Pratt \| first4 = DS. \| last5 = Mentha \| first5 = G. \| last6 = Rubbia-Brandt \| first6 = L. \| last7 = Lauwers \| first7 = GY. \| title = IgG4-associated cholangitis: a comparative histological and immunophenotypic study with primary sclerosing cholangitis on liver biopsy material. \| journal = Mod Pathol \| volume = 22 \| issue = 10 \| pages = 1287-95 \| month = Oct \| year = 2009 \| doi = 10.1038/modpathol.2009.94 \| PMID = 19633647 }}</ref>
	*Others.		*Others.

Michael: /* Staging */

2014-09-18T05:09:13Z

Staging

← Older revision		Revision as of 05:09, 18 September 2014
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	Notes:		Notes:
	*Similar to PBC staging.		*Similar to [[PBC]] staging.

	===Images===		===Images===

Michael: /* Microscopic */

2014-09-18T05:09:02Z

Microscopic

← Older revision		Revision as of 05:09, 18 September 2014
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	DDx:		DDx:
	*~~Big~~.		*IgG4-associated cholangitis.<ref>{{Cite journal \| last1 = Deshpande \| first1 = V. \| last2 = Sainani \| first2 = NI. \| last3 = Chung \| first3 = RT. \| last4 = Pratt \| first4 = DS. \| last5 = Mentha \| first5 = G. \| last6 = Rubbia-Brandt \| first6 = L. \| last7 = Lauwers \| first7 = GY. \| title = IgG4-associated cholangitis: a comparative histological and immunophenotypic study with primary sclerosing cholangitis on liver biopsy material. \| journal = Mod Pathol \| volume = 22 \| issue = 10 \| pages = 1287-95 \| month = Oct \| year = 2009 \| doi = 10.1038/modpathol.2009.94 \| PMID = 19633647 }}</ref>
			*Others.

	===Staging===		===Staging===

Michael at 05:03, 18 September 2014

2014-09-18T05:03:53Z

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	'''Primary sclerosing cholangitis''', abbreviated '''PSC''', is an uncommon [[medical liver disease]] that can afflicts the young or old, and is often associated with [[ulcerative colitis]].		'''Primary sclerosing cholangitis''', abbreviated '''PSC''', is an uncommon [[medical liver disease]] that can afflicts the young and old, and is often associated with [[ulcerative colitis]].

	'''Pericholangitis''' is considered a synonym for ''small duct PSC''.<ref>URL: [http://emedicine.medscape.com/article/181889-overview http://emedicine.medscape.com/article/181889-overview]. Accessed on: 25 January 2012.</ref>		'''Pericholangitis''' is considered a synonym for ''small duct PSC''.<ref>URL: [http://emedicine.medscape.com/article/181889-overview http://emedicine.medscape.com/article/181889-overview]. Accessed on: 25 January 2012.</ref>

Michael: /* Microscopic */ tweak

2014-09-18T05:01:47Z

Microscopic: tweak

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	*+/-Ductopenia.		*+/-Ductopenia.
	*+/-Ductal proliferation.		*+/-Ductal proliferation.

			Notes:
			*PSC often has minimal inflammation.<ref>STC. 9 December 2010.</ref>

	DDx:		DDx:
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	*[http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Primary_Sclerosing_Cholangitis-2.jpg PSC (trialx.com)].<ref>URL: [http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/ http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/]. Accessed on: 1 January 2012.</ref>		*[http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Primary_Sclerosing_Cholangitis-2.jpg PSC (trialx.com)].<ref>URL: [http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/ http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/]. Accessed on: 1 January 2012.</ref>
	*[http://www.onmedica.com/getresource.aspx?resourceid=e398a3f2-e030-40e6-823b-2e8e2cbbe4bb PSC (onmedica.com)].<ref>URL: [http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc]. Accessed on: 1 January 2011.</ref>		*[http://www.onmedica.com/getresource.aspx?resourceid=e398a3f2-e030-40e6-823b-2e8e2cbbe4bb PSC (onmedica.com)].<ref>URL: [http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc]. Accessed on: 1 January 2011.</ref>

	~~Notes:~~
	*PSC often has minimal inflammation.<ref>STC. 9 December 2010.</ref>

	==See also==		==See also==

Michael: split out

2014-09-18T05:01:09Z

split out

← Older revision		Revision as of 05:01, 18 September 2014
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	~~#redirect~~ [[~~Medical_liver_disease#Primary_sclerosing_cholangitis~~]]		'''Primary sclerosing cholangitis''', abbreviated '''PSC''', is an uncommon [[medical liver disease]] that can afflicts the young or old, and is often associated with [[ulcerative colitis]].

			'''Pericholangitis''' is considered a synonym for ''small duct PSC''.<ref>URL: [http://emedicine.medscape.com/article/181889-overview http://emedicine.medscape.com/article/181889-overview]. Accessed on: 25 January 2012.</ref>

			==General==
			*Strongly associated with [[ulcerative colitis]]; 75-90% of PSC patients have [[inflammatory bowel disease]] (IBD).<ref name=emed_psc_over>Khurana V, Singh T. Primary sclerosing cholangitis. eMedicine.com. URL: [http://emedicine.medscape.com/article/187724-overview http://emedicine.medscape.com/article/187724-overview]. Accessed on: 29 November 2009.</ref>
			*Risk for [[cholangiocarcinoma]].<ref name=pmid19668124>{{Cite journal \| last1 = Jesudian \| first1 = AB. \| last2 = Jacobson \| first2 = IM. \| title = Screening and diagnosis of cholangiocarcinoma in patients with primary sclerosing cholangitis. \| journal = Rev Gastroenterol Disord \| volume = 9 \| issue = 2 \| pages = E41-7 \| month = \| year = 2009 \| doi = \| PMID = 19668124 }}</ref>

			Serology:
			*p-ANCA (MPO-ANCA) +ve in ~ 90% of cases.<ref name=pmid11492972>{{Cite journal \| last1 = Terjung \| first1 = B. \| last2 = Worman \| first2 = HJ. \| title = Anti-neutrophil antibodies in primary sclerosing cholangitis. \| journal = Best Pract Res Clin Gastroenterol \| volume = 15 \| issue = 4 \| pages = 629-42 \| month = Aug \| year = 2001 \| doi = 10.1053/bega.2001.0209 \| PMID = 11492972 }}</ref>

			===Diagnosis===
			*'''Diagnosed radiologically'''.
			**Classically described as a ''chain of lakes''.
			*Liver biopsy is rarely useful diagnostically<ref name=emed_psc>Khurana V, Singh T. Primary sclerosing cholangitis. eMedicine.com. URL: [http://emedicine.medscape.com/article/187724-diagnosis http://emedicine.medscape.com/article/187724-diagnosis]. Accessed on: 29 November 2009.</ref> - as the disease may be patchy.
			**The utility of the biopsy is staging.

			===Treatment===
			*None very good.
			*May be indication for transplant.

			==Microscopic==
			Features:
			*Classic: "onion-skinning" - cells layer around the bile ducts; "onion skin" present in approx. 40% of cases.<ref name=medscape_psc>Steele et al. URL: [http://www.medscape.com/viewarticle/552500_6 http://www.medscape.com/viewarticle/552500_6]. Accessed on: 29 November 2009.</ref>
			**Not pathognomonic for PSC<ref name=medscape_psc/> - but not too much else looks like this on microscopy (ergo good fellowship exam question).
			*+/-Ductopenia.
			*+/-Ductal proliferation.

			DDx:
			*Big.

			===Staging===
			Features:<ref>Steele et al. URL: [http://www.medscape.com/viewarticle/552500_6 http://www.medscape.com/viewarticle/552500_6]. Accessed on: 29 November 2009.</ref>
			*Stage I - focal portal inflammation, +/- duct abnormalities, no fibrosis.
			*Stage II - portal enlargement (fibrosis), +/- inflammation.
			*Stage III - bridging fibrosis + [[necrosis]].
			*Stage IV - cirrhosis.

			Notes:
			*Similar to PBC staging.

			===Images===
			*[http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Primary_Sclerosing_Cholangitis-2.jpg PSC (trialx.com)].<ref>URL: [http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/ http://trialx.com/curebyte/2011/07/08/clinical-trials-and-images-of-primary-sclerosing-cholangitis/]. Accessed on: 1 January 2012.</ref>
			*[http://www.onmedica.com/getresource.aspx?resourceid=e398a3f2-e030-40e6-823b-2e8e2cbbe4bb PSC (onmedica.com)].<ref>URL: [http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc http://www.onmedica.com/NewsArticle.aspx?id=d7f992b5-6dee-46c6-8383-bbdfb4528ccc]. Accessed on: 1 January 2011.</ref>

			Notes:
			*PSC often has minimal inflammation.<ref>STC. 9 December 2010.</ref>

			==See also==
			*[[Medical liver disease]].

			==References==
			{{Reflist\|2}}

	[[Category:Diagnosis]]		[[Category:Diagnosis]]
			[[Category:Medical liver disease]]

Michael: +cat.

2011-10-26T04:27:51Z

+cat.

← Older revision		Revision as of 04:27, 26 October 2011
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	#redirect [[Medical_liver_disease#Primary_sclerosing_cholangitis]]		#redirect [[Medical_liver_disease#Primary_sclerosing_cholangitis]]

			[[Category:Diagnosis]]