Essential

How is primary sclerosing cholangitis diagnosed?

Primary sclerosing cholangitis (PSC) is a chronic (lasting years and decades), progressive (worsening over time) disease of the bile ducts.
- This disease channelizes bile from the liver into the intestines.
- Bile is a watery liquid made by the cells of the liver that is important for digesting food in the intestine, particularly fat.
- This liquid also helps to get rid of the body of toxins.
- Liver cells secrete the bile they make into small canals within the liver.
- The bile flows through the canals and into larger collecting canals (ducts).
- The bile then flows within the intrahepatic bile ducts out of the liver and into the extrahepatic bile ducts.
- From the extrahepatic bile ducts, the bile flows into the intestine where the bile mixes with food.

In primary sclerosing cholangitis :
- The intrahepatic and extrahepatic bile ducts become inflamed,
- scarred and thickened (sclerotic),
- narrowed,
- finally obstructed.

Obstruction of the ducts can lead to:
- abdominal pain,
- itching,
- jaundice,
- infection in the bile ducts (cholangitis),
- liver scarring that leads to liver cirrhosis,
- liver failure.

The diagnosis of primary sclerosing cholangitis inclde:
- It is suspected from the symptoms (such as fatigue, itching, and jaundice).
- Abnormal laboratory tests (such as abnormally elevated blood levels of alkaline phosphatase and other liver enzymes).
- It is confirmed by demonstration of abnormally thickened bile ducts using special radiological tests.

It is also important to exclude diseases that can mimic primary sclerosing cholangitis like:
- primary biliary cirrhosis(PBC)
- gallstones in the bile ducts
- bile duct cancers
- strictures

Blood Tests
- The blood level of alkaline phosphates is usually elevated in primary sclerosing cholangitis.
- The blood levels of other liver enzymes (AST and ALT) may also be mildly elevated.
- Except in those patients with the autoimmune form of primary sclerosing cholangitis, the bilirubin usually is normal.
- It gradually increases as the disease progress.
- Antimitochondrial antibody (AMA), which is elevated in patients with PBC, is usually normal in these patients.

Radiologic Tests
- Endoscopic retrograde cholangio-pancreatography (ERCP).
- Magnetic resonance cholangio-pancreatography (MRCP).
- These are commonly performed to visualize the intrahepatic and extrahepatic ducts.
- These ducts are typically normal in appearance in patients with PBC.
- In primary sclerosing cholangitis patients, these ducts have a beaded appearance (multiple narrowings along the ducts with areas of widening in between).
- MRCP is noninvasive and safe.
- ERCP is more invasive and carries a 5%-6% chance of causing an attack of acute pancreatitis.
- However, ERCP has the advantage of obtaining cell samples (a process called brush cytology) from the bile ducts.
- Brush cytology is not very accurate.
- It can help to diagnose cholangiocarcinoma.
- During ERCP, doctor can also insert balloons and stents across major areas of narrowing (dominant strictures).
- This is done to relieve obstruction and treat infection.

Colonoscopy
- Patients with primary sclerosing cholangitis have a high likelihood of also having ulcerative colitis.
- Patients with primary sclerosing cholangitis and ulcerative colitis have higher risks of developing colon cancer.
- Colonoscopy is important to both diagnose ulcerative colitis and for early detection of cancer.
- It is also used to study the precancerous conditions.

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Some quick tips for maintaining good health…

There are a lot of things one can do to get to a good healthy body. You can have a whole book dedicated to tips for maintaining a good health, but in today’s fast paced life, everybody looks for a summary rather than a whole novel. What we will try to do in this post is to look at some of the most common issues that can affect health and provide suggestions on how to overcome these issues.

- One of the major problem that a person face now-a-days is falling hair. Protein is very essential for maintaining good hair. To reduce hair fall, including good quality protein like soyabean or egg whites in the daily diet is very important. Also, taking vitamin B12 and consuming Brewer yeast tablets can help in reducing hair fall.

- Diabetes is getting so common now-a-days. Every second person is suffering from this disease. There are some simple tips that one can do at home to treat diabetes. One teaspoon of jamun powder or fenugreek seeds(methi) in the morning helps to reduce diabetes. Maintaining a good and healthy lifestyle is the most important measure that needs to be taken if one wants to get rid of this disease. Consumption of excess fat from your diet will improve the body’s insulin resistance.

- Constipation is another problem that people are facing now-a-days. To a greater extent, today’s lifestyle is responsible for an irregular bowel functioning. Consumption of junk food is increasing and also the stress level of the human being. Some simple tips to control constipation is to drink plenty of water daily and reduce the caffeine intake. Daily exercise which included walking for at least 45 min to 60 min is important. Also, include fresh vegetable juice in your diet.

- Dull skin can be a fairly common issue now-a-days. Some simple ways to address this issue is by ensuring that you drink enough water and fluids during the day to keep your skin hydrated. Drinking fresh vegetable juice and eating multiple servings of green vegetables and fruits during the day is also required. This needs to be supplemented with adequate amount of proteins, vitamin E and omega 3 supplements.

- To improve cardio vascular health, daily exercise which may include walking for atleast 45 min to 60 min at least 4-5 times a week is very important. In addition to walking, yoga and some breathing exercises three times a week reduces any kind of stress. In your diet, include one or two tbsp of roasted flaxseeds as it helps to increase the good cholesterol levels in the body.

- To improve metabolism, the most important tip that can be followed is eating during the first hour of having woken up. Walking is also very important to improve metabolism. Protein digestion asks the body to burn more calories and hence increasing the metabolism. So, include protein in your diet.

- To increase energy and immunity, instead of taking three big meals like breakfast, lunch, dinner, eat small frequent meals. It improves the digestion and keeps your body energetic. Include vitamin B12 supplements and wheat grass juice at least three to four times in a week.

- Discomfort during menopause is very common. To reduce it, include soya supplement in your diet as it mimics the estrogen function in the body. Also, include vitamin B6 as it prevents bloating.