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Primary Sclerosing Cholangitis — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyPrimary Sclerosing CholangitisRACP Adult Medicine

A 50-year-old man with inflammatory bowel disease presents with right upper quadrant pain and pruritus. MRCP shows multifocal strictures and dilatations of the intrahepatic bile ducts with a beaded appearance. ALP is 520 U/L, GGT 380 U/L, and bilirubin 45 µmol/L. What is the most likely diagnosis?

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Correct answer: A — Primary sclerosing cholangitis

PSC is strongly associated with IBD (especially ulcerative colitis – ~80% of PSC patients have IBD). Multifocal strictures and dilatations on MRCP creating a beaded appearance is characteristic. There is no proven medical therapy that alters the disease course; UDCA is used by some but evidence of efficacy is limited. PSC carries a lifetime risk of cholangiocarcinoma (~10–15%). Annual colonoscopy is recommended due to increased colorectal cancer risk.

Reference: eTG – 2025 – Gastrointestinal; EASL – 2022 – PSC Guidelines