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Primary sclerosing cholangitis — RCPSC IM MCQ

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HardGastroenterology/HepatologyPrimary sclerosing cholangitisRCPSC IM

A patient with ulcerative colitis has pruritus and cholestatic liver tests. Ultrasound shows no duct dilation and antimitochondrial antibody is negative. What is the best next investigation?

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Correct answer: C — Obtain magnetic resonance cholangiopancreatography

The best answer is “Obtain magnetic resonance cholangiopancreatography”. Primary sclerosing cholangitis is strongly associated with ulcerative colitis and is evaluated noninvasively with cholangiographic imaging. MRCP can show multifocal stricturing and dilation; the alternatives do not assess this ductal disorder. Direct cholangiography is reserved for therapeutic need or unresolved diagnostic uncertainty after noninvasive imaging rather than used as the initial test.

Reference: Canadian Association of Gastroenterology guideline library: https://www.cag-acg.org/guideline-library.html