PSC is diagnosed on the combination of symptoms, blood tests and a picture of the bile ducts, called a cholangiogram. A liver biopsy may be needed not only to confirm the diagnosis, but also to assess either how early or advanced the disease is.
If your GP suspects you may have the condition you will be referred to a hospital specialist for tests, expert advice and treatment. The specialist you may see could be a gastroenterologist (digestive disease specialist).
Liver function tests
Liver function tests are blood tests that are carried out to check how well the liver is functioning.
Ultrasound scan
Often the bile ducts are examined by ultrasound to exclude the possibility of other diseases. Ultrasound is a quick examination and completely painless. A special jelly, which may feel cold, is smeared on the skin over the liver and a small probe like a microphone is passed over the area. Echoes from sound waves are sent into the body and are used to build up a picture of the liver.
Liver biopsy
A liver biopsy is the procedure by which a tiny piece of the liver is taken for examination under a microscope. It is usually performed under a local anaesthetic and patients usually go home later on the same day. A fine hollow needle is passed through the skin into the liver and a small sample is withdrawn.
Cholangiography
There are two main methods of obtaining a picture of the biliary tree. Traditionally, an endoscopic cholangiogram (ERCP) is carried out. Under sedation a thin tube (endoscope) containing a small camera is passed through the mouth into the small bowel (the duodenum) via the stomach. A tiny tube is then passed through the endoscope into the bile ducts, dye (contrast media) is injected and X-rays are taken to produce a picture of the bile ducts.
A newer method is a tubeless test called magnetic resonance cholangiogram (MRCP) although the picture quality is not quite as good as ERCP. This means lying in a scanner which can be a little claustrophobic for some people.