What are the symptoms of PSC?
The main symptoms of PSC are itching, fatigue, and yellowing of the skin or whites of the eyes. An infection in the bile ducts can cause chills and fever. PSC progresses slowly, so a person can have the disease for years before symptoms develop.

How is PSC diagnosed?
Blood tests to check levels of liver enzymes are the first step in diagnosing PSC. Dr. Jones will confirm the diagnosis using cholangiography, which provides pictures of the bile ducts.

Cholangiography can be performed in the following ways:

• Endoscopic retrograde cholangiopancreatography (ERCP): ERCP uses an endoscope that goes down the mouth, beyond the stomach, and into the duodenum to reach an area in the digestive tract where dye can be injected into the bile ducts. X-rays are taken when the dye is injected. ERCP also can be used to take a tissue sample or to treat blocked ducts.
• Percutaneous transhepatic cholangiography: This procedure involves inserting a needle through the skin and placing a thin tube into a duct in the liver. Dye is injected through the tube and x-rays are taken.
• Magnetic resonance cholangiopancreatography (MRCP): MRCP uses magnetic resonance imaging (MRI) to obtain pictures of the bile ducts. MRI machines use radio waves and magnets to scan internal organs and tissues.

Other testing may include ultrasound exams and a liver biopsy. Ultrasound uses sound waves to create images of organs inside the body. A biopsy involves removal of a small piece of tissue for examination with a microscope.