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Primary sclerosing cholangitis — RACP Adult Medicine MCQ

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ModerateGastroenterology and hepatologyPrimary sclerosing cholangitisRACP Adult Medicine

A 41-year-old man with long-standing ulcerative colitis has pruritus and cholestatic liver enzymes. Bilirubin is mildly raised and antimitochondrial antibody is negative. Ultrasound shows no gallstones or biliary dilatation. What is the most appropriate investigation?

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Correct answer: E — Magnetic resonance cholangiopancreatography

PSC is associated with ulcerative colitis and is investigated with MRCP to show multifocal biliary stricturing. A HIDA scan evaluates gallbladder function rather than intrahepatic strictures. Amylase, capsule endoscopy and unplanned therapeutic ERCP do not provide the safest diagnostic pathway.

Reference: GESA hepatology guidance; eTG