Primary Sclerosing Cholangitis
Primary Sclerosing Cholangitis is a chronic and long-term disease that leads to the damage of the bile ducts which become inflamed, narrow and prevent the bile from flowing. The reason for the bile to get blocked is inflammation or scarring. This causes the bile juices to get collected in the liver, where it damages the cells of the liver and leads to cirrhosis or fibrosis of liver. After cirrhosis, the liver loses its ability to function. PSC is more often seen in men in the 20-30 age range.
PSC develops slowly. Usually liver failure occurs after 10-15 years of diagnosis, however it may vary in some patients. Most patients with PSC need a liver transplant after 10 years from being diagnosed of the disease. Primary Sclerosing Cholangitis can also lead to bile cancer.
- Bacterial or viral infections.
- Ulcerative Colitis: an inflammatory bowel disease.
- Problems in the immune system.
- Genetic factors.
- Crohn’s disease.
- Hepatomegaly, enlarged liver.
- Enlarged spleen.
- Portal hypertension
- Hepatic encephalopathy, disturbance caused by dysfunction of the liver.
- Pruritus or itching.
- Pain in the upper right side of the abdomen.
- Loss of weight.
- Night sweats.
- A feeling of tiredness.
- Sweating at night.
- Blood tests: Doctors recommend a complete blood count and Liver function Tests to check the functioning of the liver such as the levels of liver enzymes.
Imaging tests: Like X-ray, MRI help in creating images of the bile ducts, which helps in diagnosing Primary Sclerosing Cholangitis. Moreover, an X-ray of the bile duct called Endoscopic Retrograde CholangioPancreatography (ERCP) is also used. ERCP is rarely used for diagnosis, owing to its complications.
- Colonoscopy: Patients with PSC are prone to ulcerative colitis, which can lead to colon cancer. Thus, this test is recommended by the doctors. In this process, the doctor views the inside of the colon or the rectum.
- Liver biopsy: This includes the examination of an extracted tissue of liver by the doctors.
- Balloon dilation: balloon dilation is a technique somewhat similar to Cardiac Balloon Angioplasty, Its an endoscopic procedure where doctors run a slender tube with an inflatable balloon at its tip (balloon catheter) into a blocked bile duct. Once the balloon catheter is in place, the balloon is inflated.
- Stent placement: In this procedure, doctors use an endoscope and attached instruments to place a small plastic tube called a stent in a blocked bile duct to hold the duct open.
- Medications: Ursodiol or ursodeoxycholic acid (UDCA) is given. Also, itching is treated with the help of antihistamines like diphenhydramine, hydroxyzine and cyproheptadine. Moreover, Cholestyramine is administered, which is useful for binding bile salts together.
- Liver transplant: This process involves the transfer of healthy liver in the body of patient, from the body of the donor.
Life after surgery:
Liver transplants are usually a great success. According to the most recent year computed UNOS/OPTN (2004) national average one-year graft survival at 83%, and patient survival at 87% for patients receiving a deceased donor liver and 92% for those transplanted with an organ from a living donor.
After a liver transplant, a patient is recommended to stay in the I.C.U for a few days and then later shifted to the transplant recovery area for 5-10 days. The patient can then go back to normal day-to-day activities. Regular follow-ups are advised and patients have to take the medicines for lifetime.
Risks involved in a liver transplant include:
- Organ rejection.
- Failure of the donated liver.
- Clots of blood.
- Bile duct leaks.
- Shrinking of bile ducts.
- Recurrence of Liver disease in the Transplanted Liver( Long Term complication)
Studies suggest that life expectancy ranges from 9 to 18 years if the patient does not undergo liver transplantation. Life expectancy may be longer than 21 years from the time when the diagnosis is made.
The prognosis and life expectancy is poorer in older patients, those who have an enlarged liver and spleen, and in patients who are persistently jaundiced with elevated bilirubin levels in their bloodstream.
In the late 90s, when the first successful liver transplants were done in India, the procedure cost Rs.20 lakh. Now, a resection costs between Rs.3 and 4 lakh and a transplant Rs.20-25 lakh in a private hospital.
New Life Clinics offers a low-risk way to treat Primary Sclerosing Cholangitis. Our team of experienced and skilled doctors make life at hospital a painless one and guarantee a speedy recovery. In case of any inquiry of treatments, contact us: