How is PSC diagnosed?

There is no single diagnostic blood test for PSC.

This means that your doctors need to piece together clues from your medical history, blood tests, symptoms and scans to make a diagnosis.


PSC Basics Video Two

Dr James Ferguson explains how PSC is diagnosed:

The diagnosis often comes unexpectedly after your routine blood tests for IBD suggest bile duct injury 10. In other cases, people suffer with fatigue or feel generally unwell, or may show signs of liver disease such as itch or jaundice, which triggers investigations to identify the cause.

Where there is any doubt about your PSC diagnosis, you should ask to be referred to a hospital or doctor with experience or an interest in PSC.


Blood tests

Investigations often begin following liver blood test results showing a pattern of damage indicating injury to the biliary tree 52

However, because liver blood tests look normal in some people with PSC 2,10, blood tests alone cannot be used to diagnose it or rule it out.

Blood tests information


Medical history

Your doctor will also consider other factors, such as whether or not you have inflammatory bowel disease (IBD) or other autoimmune diseases. Around 70%-80% of people with PSC have IBD, and its presence is a strong indicator to check for PSC 1,52. Furthermore, nearly a quarter will have or develop another autoimmune condition 46.


Imaging

If your doctor suspects PSC, you will be asked to have a type of MRI scan called an MRCP scan. An MRCP looks closely at your bile ducts. It is the gold standard and the test of choice for diagnosing PSC 2,59. If you have PSC, MRCP will typically show an irregular biliary tree, with a beaded appearance characterised by strictures and dilatations.

More about MRCP scans


Liver biopsy (if necessary)

Where the MRCP shows a typical appearance for PSC, a liver biopsy is rarely undertaken. However, occasionally a biopsy is taken when small duct PSC, IgG4-sclerosing cholangitis or autoimmune hepatitis is suspected 10,106.
More about liver biopsies


Is it definitely PSC? 

Once PSC is diagnosed, your doctor will check blood tests to rule out IGg4-associated cholangitis 1,59 and sometimes cholangiocarcinoma as these can mimic and/or complicate PSC 10.
 

Just diagnosed?

Now you will undergo routine care and monitoring to look after you and manage any symptoms you may have.

What to expect from your routine care

Tips from people with PSC on handling your diagnosis

Quality information: this information has been reviewed by a panel (Q1) of patients and experts.
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