PSC Flashcards
(24 cards)
MRCP is preferred over ERCP to establish a diagnosis of PSC
strong, moderate evidence
Liver biopsy is not necessary to make a diagnosis in patients w/ suspected PSC based on diagnostic cholangiographic findings
conditional, low evidence
Liver biopsy is recommended to make a diagnosis in patients w/ suspected small duct PSC or to exclude other conditions such as suspected overlap w/ autoimmune hepatitis
conditional, moderate evidence
Antimitochondrial autoantibody testing can help exclude primary biliary cirrhosis
conditional, moderate evidence
Patients w/ PSC should be tested at least once for elevated serum IgG4 levels
conditional, moderate evidence
UDCA in doses >28 mg/kg/day should not be used for management of patients w/ PSC
strong, high evidence
ERCP w/ balloon dilatation is recommended for PSC patients w/ dominant stricture and pruritus, and/or cholangitis, to relieve symptoms
strong, low evidence
PSC w/ a dominant stricture seen on imaging should have an ERCP w/ cytology, biopsies and FISH to exclude diagnosis of cholangiocarcinoma
strong, low evidence
PSC patients undergoing ERCP should have antibiotic prophylaxis to prevent post-ERCP cholangitis
conditional, low evidence
Routine stenting after dilation of a dominant stricture is not required, whereas short-term stenting may be required in patients w/ severe stricture
conditional, low evidence
Liver transplantation, when possible, is recommended over medical therapy or surgical drainage in PSC patients with decompensated cirrhosis, to prolong survival
strong, moderate evidence
Patients should be referred for liver transplantation when their MELD score exceeds 14
conditional, moderate evidence
Annual colon surveillance preferably w/ chromoendoscopy is recommended in PSC patients w/ colitis beginning at the time of PSC diagnosis
conditional, moderate evidence
A full colonoscopy w/ biopsies is recommended in patients w/ PSC regardless of the presence of symptoms to assess for associated colitis at the time of PSC diagnosis
conditional, moderate evidence
Some advocate repeating colonoscopy every 3-5 years in those without prior evidence of colitis
weak, low evidence
Consider screening for cholangiocarcinoma w/ regular cross-sectional imaging w/ ultrasound or MR and serial CA 19-9 every 6-12 months
conditional, very low evidence
Cholecystectomy should be performed for patients w/ PSC and gallbladder polyps >8mm, to prevent the development of gallbladder adenocarcinoma
conditional, very low evidence
Further testing for autoimmune hepatitis is recommended for patients < 25 years of age w/ PSC or those w/ higher-than-expected levels of aminotransferases usually 5x ULN
conditional, moderate evidence
MRCP is recommended for patients < 25 years of age w/ autoimmune hepatitis, who have elevated serum ALP usually > 2x the ULN
conditional, moverate evidence
Local skin treatment should be performed w/ emollients and/or antihistamines in patients w/ PSC and mild pruritus, to reduce symptoms
conditional, very low evidence
Bile acid sequestrants such as cholestyramine should be taken (prescribed) in patients w/ PSC and moderate pruritus, to reduce symptoms. Second-line treatment such as rifampin and naltrexone can be considered if cholestyramine is ineffective or poorly tolerated.
conditional, very low evidence
Recommend screening for varices in patients w/ signs of advanced disease w/ platelet counts <150,000
conditional, very low evidence
Patients w/ PSC should undergo BMD screening at diagnosis w/ DEXA at diagnosis and repeated at 2-4 yr intervals
conditional, moderate evidence
Patients w/ advanced liver disease should be screened and monitored for fat-soluble vitamin deficiencies
conditional, moderate evidence
