Re: Symptoms of PSC

July 2, 2007

> >

> > My daughter aged 24 has recently been having bouts of nausea,

stomach

> > pain and sickness. She has Ulcerative Colitis and her consultand

> treats her with Urso as she has fluctuating high lft's.She had a

Liver

> biopsy 2 years ago. Are these symptoms of PSC? She attends a local

> hospital and they dont seem to know how to treat her. I would like

her

> to be transfered to a specialist Liver Unit.

>

Thank you for your replies. She was told by her original Consultant

2yrs ago that they were not certain she has PCS as although she had a

Liver biopsy it was inconclusive but she does seem to have raised ALP

ALT AST not sure about GGT but sometimes they are OK.He said that we

should assume she has PSC and put her on Urso. She did find Urso made

her nauseous the first week she took it but now she is ok with it.

When she was at University 3 yrs ago she did complain to me about

having bouts of fever and shivering which she put down to flu and

colds. This was when her ALT AST and ALP were found to be high. She

has just been allowed home from hospital after another flare up of

nausea.severe stomach pain and vomiting. I just feel that we need a

definite diagnosis. The hospital are putting her symptoms down to

Ulcerative Colitis and seem to be ignoring the possibility of PSC.

July 2, 2007

Your daughter's elevated ALP suggests bile-duct involvement. But

probably the only way to get a DEFINITE diagnosis would be to have an

MRCP or ERCP:

" Typical serum biochemical results, autoantibodies and liver biopsy are

suggestive but not diagnostic of PSC, the diagnosis requiring

cholangiographic demonstration of stricturing and dilatation of the

intra- and/or extra-hepatic bile ducts. " (LaRusso NF, Shneider BL,

Black D, Gores GJ, SP, Doo E, Hoofnagle JH 2006 Primary

sclerosing cholangitis: summary of a workshop. Hepatology 44: 746-764)

MRCP

http://www.ercp.ucla.edu/pages/info/procedures/mri-mrcp.html

ERCP

http://www.ercp.ucla.edu/pages/info/procedures/ercp.html

Only small-duct PSC would not be detected by these methods.

Best regards,

Dave

> Thank you for your replies. She was told by her original Consultant

> 2yrs ago that they were not certain she has PCS as although she had a

> Liver biopsy it was inconclusive but she does seem to have raised ALP

> ALT AST not sure about GGT but sometimes they are OK.He said that we

> should assume she has PSC and put her on Urso. She did find Urso made

> her nauseous the first week she took it but now she is ok with it.

> When she was at University 3 yrs ago she did complain to me about

> having bouts of fever and shivering which she put down to flu and

> colds. This was when her ALT AST and ALP were found to be high. She

> has just been allowed home from hospital after another flare up of

> nausea.severe stomach pain and vomiting. I just feel that we need a

> definite diagnosis. The hospital are putting her symptoms down to

> Ulcerative Colitis and seem to be ignoring the possibility of PSC.

July 3, 2007

The things you are describing sound like

what I experienced when I started to be symptomatic. I had nausea, stomach ache

and vomiting. When I went to my hepatologist with my complaints I was scheduled

for an ERCP. During the ERCP a balloon was used to open the bile ducts. ERCP is

not fun, but well worth the trouble in my opinion. I haven't had any symptoms

since this ERCP more than a year and a half ago and my LFTs are almost normal. Another

advantage of ERCP is that it is a very good tool (the best I think) to diagnose

PSC.

Chaim Boermeester, Israel