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Primary Sclerosing Cholangitis — RACP Adult Medicine MCQ

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ModerateGastroenterologyPrimary Sclerosing CholangitisRACP Adult Medicine

A 30-year-old man with ulcerative colitis presents with fatigue, pruritus, and elevated ALP (380 U/L) and GGT (290 U/L). AMA is negative. MRCP shows multifocal strictures and dilatations of the intrahepatic and extrahepatic bile ducts (beaded appearance). What is the most likely diagnosis?

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Correct answer: A — Primary sclerosing cholangitis

PSC is strongly associated with IBD (especially UC). Characteristic MRCP findings of multifocal strictures with beaded appearance of bile ducts, negative AMA, and elevated cholestatic enzymes are diagnostic. PSC increases the risk of cholangiocarcinoma. No pharmacological therapy has proven disease-modifying efficacy.

Reference: EASL – 2022 – PSC Guidelines; Gastroenterological Society of Australia