Question: How do doctors diagnose PSC?
Answer: Doctors diagnose primary sclerosing cholangitis (PSC) based on medical and family history, a physical exam, and the results of medical tests.

Medical and family history

The doctor will ask about your symptoms. He or she may also ask whether you have

a history ofinflammatory bowel disease (IBD), particularlyulcerative colitis
a parent or sibling who has PSC or IBD
a personal or family history ofautoimmune diseases, such asautoimmune hepatitis,type 1 diabetes,celiac disease, andthyroid diseases

Physical exam

Your doctor will examine your body, including your abdomen. He or she will check for

signs ofcirrhosisandliver failure, such asjaundice, which can make the whites of the eyes and skin look yellow
scratch marks from scratching itchy skin
signs that theliverandspleenare larger than they should be
tenderness or pain in the abdomen
Question: What tests do doctors use to diagnose PSC?
Answer: Blood tests

A health care professional will take a blood sample from you and send the sample to a lab.

Liver tests can show abnormal levels of liver enzymes and other substances in your blood. Abnormal levels of certain liver enzymes may be a sign your liver or bile ducts are damaged.

Imaging tests

To diagnose PSC, doctors typically order a special imaging test to examine the bile ducts, such as

magnetic resonance cholangiopancreatography (MRCP), which uses amagnetic resonance imaging (MRI)machine to create pictures of the bile ducts. MRCP is the most common test that doctors use to diagnose PSC.
endoscopic retrograde cholangiopancreatography (ERCP), which combinesupper gastrointestinal (GI) endoscopyandx-raysto examine the bile and pancreatic ducts. Doctors may also use ERCP totreatnarrowed bile ducts.
percutaneous transhepatic cholangiography (PTC), which is an x-ray of the bile ducts. A health care professional inserts a needle through the skin and into the liver to inject a special dye into the bile ducts. The special dye lets a doctor see the bile ducts on the x-ray.

Doctors may also order other imaging tests to check for signs of PSC, other bile duct or liver problems, or complications. These tests include

ultrasound, which uses a hand-held device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure.
computed tomography (CT) scans, which uses a combination of x-rays and computer technology to create images of the liver.
elastography, a special test that measures the stiffness of the liver. Increased liver stiffness may be a sign of fibrosis, or scarring.

Liver biopsy

A liver biopsy is generally not needed to diagnose PSC. However, in some cases, doctors may order a liver biopsy to check for signs of other liver diseases, such as autoimmune hepatitis.

During a liver biopsy, a doctor will take small pieces of tissue from the liver. A pathologist will examine the tissue under a microscope.

Colonoscopy

For people who have PSC and haven’t already been diagnosed with IBD, doctors may recommend a colonoscopy to check for IBD. Many people with PSC have mild IBD and don’t have IBD symptoms.