Since people with PSC may not notice symptoms for many years, the disease often is suspected due to abnormal blood tests (taken for other reasons). These blood tests show a high level of liver enzymes (which indicate abnormal liver function). The disease also might be suspected due to a history of inflammatory bowel disease.
X-ray tests can show if bile ducts are blocked, but they may not be able to determine the cause or site of the possible obstruction.
Sclerosing cholangitis is diagnosed by blood tests, along with radiologic imaging. Cholangiography is “taking a picture of the bile ducts.” The first choice for imaging includes injecting dye into the bile ducts and taking a magnetic resonance cholangiography (MRCP). The test can find the cause and site of the blockage. Many times a liver biopsy is also needed to confirm diagnosis and figure out how the disease has progressed.
Other tests that can be used to help with the diagnosis are:
- Endoscopic retrograde cholangiography (ERCP). Dye is injected into a lighted and flexible endoscope (tool used to look at the inside of some body parts). It is inserted through the mouth, stomach and then into the small intestine. A thin tube is placed through the scope and into the pancreatic and bile ducts. The dye is used to show the bile ducts on the X-ray.
- Percutaneous transhepatic cholangiography. A dilated (enlarged) bile duct is found with an ultrasound. A needle punctures the skin and places dye directly into the bile duct. X-rays are taken to find blockage.
All of these tests are done with the child sedated (given a medicine that has a soothing and calming effect) or with anesthesia (medicine given to put the child in a deep sleep with support to breathing available).