Primary Sclerosing Cholangitis

PSC gradually narrows and destroys bile ducts. The resulting impaired bile flow can remain clinically quiet while inflammation and fibrosis accumulate, then declare itself through jaundice, cholangitis, cirrhosis or malignancy. The useful clinical model is therefore broader than an abnormal alkaline phosphatase: confirm the biliary pattern, identify obstruction or infection, look for often-silent inflammatory bowel disease, and establish surveillance from the time of diagnosis. In Canada, diagnostic testing, prescribing and referral occur within provincial NP authorization and local hepatology, gastroenterology and transplant pathways.