Question: 34 year old male with history of ulcerative colitis(UC) is admitted to ICU with dehydration secondary to diarrhea. Initial lab testing is consistent with electrolyte abnormality but marked elevation of alkaline phosphatase. What is your concern?
Answer: Primary sclerosing cholangitis (PSC)
Patients with UC are at very high risk of developing PSC. Pathology is thought to be same i.e autoimmunity. To make things complicated, it increases the risks of cholangiocarcinoma as well as colorectal cancer. In synchrony with UC, treatment consists of immunosuppressants, chelators and steroids. Symptomatic relief can be provided with endoscopic dilation and stenting of strictures, but it does not reverse the disease progression. Liver transplantation is the last hope.
Patients with UC are at very high risk of developing PSC. Pathology is thought to be same i.e autoimmunity. To make things complicated, it increases the risks of cholangiocarcinoma as well as colorectal cancer. In synchrony with UC, treatment consists of immunosuppressants, chelators and steroids. Symptomatic relief can be provided with endoscopic dilation and stenting of strictures, but it does not reverse the disease progression. Liver transplantation is the last hope.
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