There are a number of symptoms associated with PSC that might develop during the course of the disease, however it is very variable as to which person will develop which symptom and when in the disease process this might occur.

Itching (pruritius): An intense itch usually starting with the feet, hands and ankles but can involve other parts of the body. It is a common and often debilitating symptom of PSC. This only occurs in significant jaundice due to collection of bile salts in the skin: hence in PSC means significant obstruction. According to Chapman (2010) the management of pruritus in PSC "should prompt consideration of a dominant stricture" (p.664)

Fatigue and insomnia: It is unclear why PSC causes fatigue, with suggestions  that the psychological stresses combined with physical pain, may be determinants. It may also be a result of loss of nutrients, vitamins and minerals that occur from PSC. Pain, depression, fatigue may all then impact on sleep patterns causing insomnia, thereby impacting on quality of life. (PSC Support UK)

Jaundice:  A condition marked by yellow staining of body tissues and fluids, as a result of excessive levels of bilirubin in the bloodstream. Jaundice is not usually visible until the total bilirubin level rises above 51 umol/L (3 mg/dl). Deposits of bilirubin in the skin often cause itching. 

Right Upper Quadrant pain: This is a common pain experienced by people with PSC and refers to pain in the upper right part of the abdomen, just below the rib cage which may also extend to other surrounding areas of the body.

Depression: This can develop from dealing with the impact of diagnosis of PSC and the subsequent implications to quality of life, as well as the impact of PSC on goals and future plans. 

Biliary stones: The exact cause is unknown. Stones can be found in the gallbladder and occasionally in the common bile duct. The consequences depend on their location whether this causes obstruction to flow, and whether there is any associated infection. Stones in the gallbladder in the absence of infection, can cause biliary colic which is usually experienced as midline, epigastric pain sometimes radiating through to the back, which occurs in waves. This usually settles with pain relief. If the stones in the gallbladder become infected cholecystitis ensues. In this case the pain is localised to the right upper quadrant over the gallbladder and is especially painful when pressure is applied over the gallbladder, for example a hand, and you have a deep breath (Murphy's sign). In this circumstance there may be generalised features of infection, for example, fever, raised heart rate. This usually requires antibiotics as well pain relief to bring under control. A stone in the common bile duct may cause obstruction leading to jaundice and possibly infection in the common bile duct. A stone at the lower end of the bile duct can cause obstruction to the pancreatic duct, leading to pancreatitis, severe upper abdominal pain radiating through to the back. More information may be found here.

References:
Chapman, R, et. al, Diagnosis and Management of Primary Sclerosing Cholangitis, Hepatology, 2010, 51 (2), pp 660-678

Page Created: 01.04.2014
Updated: 13.04.2014
Page Reviewed: 04.09.2015