PSC can lead to various complications, including

• Deficiencies of vitamins A, D, E, and K: These are fat-soluble vitamins which means they dissolve in fat. One of the roles of bile is to help fat be broken down and allow these vitamins to be absorbed.
• Osteoporosis: Osteoporosis causes bones to become weak and brittle over time, and occurs when bones lose an excessive amount of the protein and mineral content, especially calcium.  Bone mass and bone strength is therefore decreased. Osteopenic bone disease occurs frequently among patients with chronic liver disease. A study by Angulo and colleagues in 2011, and published in Gastroenterology,  found that patients with PSC lost 1% of bone loss per year and the rate of loss was significantly associated with the duration of inflammatory bowel disease. The study by Chapman et al, found that the rate of osteoporosis in PSC was between 4% and 10% and suggest regular screening at 2-3 year intervals.
• Infective cholangitis: Infections of the bile ducts which may cause chills, fever, and abdominal tenderness.
• Portal Hypertension: This refers to high blood pressure in the portal vein, which is the vein that brings blood from the intestine to the liver. Blood in the portal vein, passing from the intestines to the liver, meets resistance due to liver disease. The increased blood pressure causes blood to be diverted into small veins in the walls of the oesophagus and stomach. These veins may become distended (known as oesophageal varices) and rupture, causing vomiting of blood and black faeces. Additionally renal complications and other issues may result.
  
• Bacterial cholangitis: A bacterial infection of the bile ducts, which is more common in the presence of obstruction (acute or chronic). Acute cholangitis can lead to septicaemia, shock and death. According to PSC Support UK: "cholangitis complicating PSC frequently does not present with the classical symptoms of high fever, severe pain and high white cell count and can involve a spectrum of less specific symptoms". As this is potentially fatal, it is important to be aware of the possible symptoms of a cholangitis attack, even if asymptomatic with PSC. Symptoms can include itching, dark urine, temperature, shivers and chills, Right Upper Quadrant pain, jaundice, fever, pale stools, nausea/vomiting, and/or night sweats. (PSC Support UK)
  
• Cirrhosis: Extensive scarring of the liver
• Liver failure
• Bile duct cancer

Page Created: 23.03.2014
Reviewed: 04.09.2015