Back from my F/U appt.

[Guest guest]

I saw Dr. Pratt at MGH again today. I must say, I really, really like him. He

clearly is jazzed

up about what he does!

All in all, it was a good visit. He wants me in for an ERCP (what a surprise, I

knew that

would be the case) to take brushings and do a dilation.

Here is the info from the liver biopsy report:

Bile ductopenia, mild portal chronic inflammation, focal ductoular

proliferation and portal

and periportal fibrosis with short septae and sinusoidal collagen deposition

(trichrome

stain).

Note: No iron or intrahepatocytic d-PAS globules are seen. The findings are

compatible

with the history of PSC, stage 2-3 of 4.

And the MRCP:

Biliary: There is mild prominence of the bilateral intrahepatic bile ducts.

There is also

narrowing at the confluence of the left and right hepatic ducts with dilation of

the

common bile duct immediately distal to this narrow. In the region of the

narrowing at the

confluence of the hepatic ducts, there is mild heterogeneous enhancement.

Impression:

1 Prominence of the bilateral intrahepatic bile ducts and dilation of the common

bile duct

as described consistent with known diagnosis of PSC.

2 Narrowing at the confluence of the left and right hepatic ducts with

heterogeneous

enhancement in this area. While this may be related to the underlying PSC, an

underlying

cholangiocarcinoma cannot be excluded. ERCP is recommended.

Colleen commenting here again:

So, we talked. He doesn't think I have bile duct cancer, but have active

inflammation. He

still wants to have an ERCP done to open up the strictures and help that flow of

bile, and to

take brushings as well -- and see what the pathology on those are. His opinion

is that I

am stage 2, not 3. And the goal is to keep me from progressing further. Fingers

are

crossed that we succeed.

As far as the treatment is concerned, we are looking at high dose Urso and a

type of

prednisone used to treat PBC. Apparently it doesn't have the same side-effects

that the

plain old pred does, which sounds good to me.

So Jens and I are talking and figuring out which family member we can hit up

this time to

help with watching the kids so I can go into Boston for the ERCP. Fun, Fun, Fun!

Goodnight,

Colleen

P.S. Have fun in ville -- we are heading to Maine for a birthday party!