BOF: 2
A 26-year-old male attends the inflammatory bowel
disease clinic for follow up of long standing ulcerative colitis.
Routine investigation has revealed a high alkaline
phosphatase level.
Which of the following tests would you arrange in order
to further investigate this patient?
a)
Endoscopic retrograde cholangio pacreatography (ERCP)
b)
Magnetic resonance cholangio pacreatography (MRCP)
c)
ANCA levels
d)
Liver biopsy
e)
CT abdomen
Answer: b)
In a young patient with ulcerative colitis the finding of
a raised alkaline phosphatase should make you suspect sclerosing cholangitis.
To confirm this the best test would be MRCP
ERCP has associated morbidity and mortality and would not
be considered the first choice investigation.
ANCA levels are not specific although they may be raised
in sclerosing cholangitis.
Liver biopsy would be considered too invasive as the
first line of investigation and would be reserved for cases in which there is
diagnostic difficulty
Revision Tip
Revise PSC KEYS to SUCCESS in
Medicine page 294-295
