Guest guest Posted January 28, 2009 Report Share Posted January 28, 2009 How do you know if you have small or large duct PSC? Sounds like it is better to have small duct psc but it also sounds like small duct PSC eventually turns into large duct PSC. Thanks for the good info. Lori A. "Aggressively Pursuing Solutions To Your Real Estate Needs!" First Weber Group Cell: 1507 E. Sunset Drive Waukesha, WI 53189 LoriUSA@... www.Lori.FirstWeber.com To: Sent: Tuesday, January 27, 2009 10:18:55 PMSubject: Small-duct PSC Curr Gastroenterol Rep. 2009 Feb;11(1):37- 41.Small-duct primary sclerosing cholangitis.Björnsson EDepartment of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Med pol II, SE-413 45 Gothenburg, Sweden. einar.bjornsson@ medic.gu. se.Patients with cholestatic liver tests and typical histologic features of primary sclerosing cholangitis (PSC) but a normal cholangiogram have been identified as having small-duct PSC. This subgroup of PSC has been less well characterized than the classic large-duct form. Some patients characterized as having small-duct PSC develop cholangiographic features of PSC during follow-up. Three papers published in 2002 on small-duct PSC patients suggested a better prognosis in patients with small-duct PSC than in those with large-duct PSC. However, these studies included a limited number of patients and had a short follow-up. A combined cohort of these patients with a prolonged follow-up recently confirmed these previous observations. However, some patients will suffer from liver-related mortality or will need to undergo liver transplantation. Recurrence of small-duct PSC after liver transplantation has been reported. Cholangiocarcinoma, the most feared complication of PSC, has not been described in a patient with small-duct PSC without progression first to large-duct PSC. PMID: 19166657.Dave (father of (23); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2009 Report Share Posted January 28, 2009 How do you know if you have small or large duct PSC? Sounds like it is better to have small duct psc but it also sounds like small duct PSC eventually turns into large duct PSC. Thanks for the good info. Lori A. "Aggressively Pursuing Solutions To Your Real Estate Needs!" First Weber Group Cell: 1507 E. Sunset Drive Waukesha, WI 53189 LoriUSA@... www.Lori.FirstWeber.com To: Sent: Tuesday, January 27, 2009 10:18:55 PMSubject: Small-duct PSC Curr Gastroenterol Rep. 2009 Feb;11(1):37- 41.Small-duct primary sclerosing cholangitis.Björnsson EDepartment of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Med pol II, SE-413 45 Gothenburg, Sweden. einar.bjornsson@ medic.gu. se.Patients with cholestatic liver tests and typical histologic features of primary sclerosing cholangitis (PSC) but a normal cholangiogram have been identified as having small-duct PSC. This subgroup of PSC has been less well characterized than the classic large-duct form. Some patients characterized as having small-duct PSC develop cholangiographic features of PSC during follow-up. Three papers published in 2002 on small-duct PSC patients suggested a better prognosis in patients with small-duct PSC than in those with large-duct PSC. However, these studies included a limited number of patients and had a short follow-up. A combined cohort of these patients with a prolonged follow-up recently confirmed these previous observations. However, some patients will suffer from liver-related mortality or will need to undergo liver transplantation. Recurrence of small-duct PSC after liver transplantation has been reported. Cholangiocarcinoma, the most feared complication of PSC, has not been described in a patient with small-duct PSC without progression first to large-duct PSC. PMID: 19166657.Dave (father of (23); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2009 Report Share Posted January 28, 2009 I have small duct PSC - what it means is that when they do my MRCP and Biopsies that I show that My small ducts are being destroyed but my large ducts or the main Biliary tree has not been attacked to much yet. For me, My last MRCP indicated that I was begining to develop large duct PSC also. Hope this helps Dawn > > How do you know if you have small or large duct PSC? Sounds like it is better to have small duct psc but it also sounds like small duct PSC eventually turns into large duct PSC. Thanks for the good info. > > Lori A. > > " Aggressively Pursuing Solutions To Your Real Estate Needs! " > > First Weber Group > Cell: > 1507 E. Sunset Drive > Waukesha, WI 53189 > LoriUSA@... > www.Lori.FirstWeber.com > > > > > > ________________________________ > From: > To: > Sent: Tuesday, January 27, 2009 10:18:55 PM > Subject: Small-duct PSC > > > Curr Gastroenterol Rep. 2009 Feb;11(1):37- 41. > > Small-duct primary sclerosing cholangitis. > > Björnsson E > > Department of Internal Medicine, Section of Gastroenterology and > Hepatology, Sahlgrenska University Hospital, Med pol II, SE-413 45 > Gothenburg, Sweden. einar.bjornsson@ medic.gu. se. > > Patients with cholestatic liver tests and typical histologic features > of primary sclerosing cholangitis (PSC) but a normal cholangiogram > have been identified as having small-duct PSC. This subgroup of PSC > has been less well characterized than the classic large-duct form. > Some patients characterized as having small-duct PSC develop > cholangiographic features of PSC during follow-up. Three papers > published in 2002 on small-duct PSC patients suggested a better > prognosis in patients with small-duct PSC than in those with large- > duct PSC. However, these studies included a limited number of > patients and had a short follow-up. A combined cohort of these > patients with a prolonged follow-up recently confirmed these previous > observations. However, some patients will suffer from liver-related > mortality or will need to undergo liver transplantation. Recurrence > of small-duct PSC after liver transplantation has been reported. > Cholangiocarcinoma, the most feared complication of PSC, has not been > described in a patient with small-duct PSC without progression first > to large-duct PSC. PMID: 19166657. > > Dave > (father of (23); PSC 07/03; UC 08/03) > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2009 Report Share Posted January 28, 2009 Interesting article. And it's from Gothenburg, Sweden - where my relatives live. I'm familiar with Sahlgrenska Hospital - I went there when I lived in Sweden (a number of decades ago).Marie To: From: rhodesdavid1@...Date: Wed, 28 Jan 2009 04:18:55 +0000Subject: Small-duct PSC Curr Gastroenterol Rep. 2009 Feb;11(1):37-41. Small-duct primary sclerosing cholangitis. Björnsson E Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Med pol II, SE-413 45 Gothenburg, Sweden. einar.bjornsson (AT) medic (DOT) gu.se. Patients with cholestatic liver tests and typical histologic features of primary sclerosing cholangitis (PSC) but a normal cholangiogram have been identified as having small-duct PSC. This subgroup of PSC has been less well characterized than the classic large-duct form. Some patients characterized as having small-duct PSC develop cholangiographic features of PSC during follow-up. Three papers published in 2002 on small-duct PSC patients suggested a better prognosis in patients with small-duct PSC than in those with large- duct PSC. However, these studies included a limited number of patients and had a short follow-up. A combined cohort of these patients with a prolonged follow-up recently confirmed these previous observations. However, some patients will suffer from liver-related mortality or will need to undergo liver transplantation. Recurrence of small-duct PSC after liver transplantation has been reported. Cholangiocarcinoma, the most feared complication of PSC, has not been described in a patient with small-duct PSC without progression first to large-duct PSC. PMID: 19166657. Dave (father of (23); PSC 07/03; UC 08/03) Hotmail® goes where you go. On a PC, on the Web, on your phone. See how. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2009 Report Share Posted January 28, 2009 I have small-duct PSC. They had a hard time diagnosing me, and for awhile thought that I had PBC because the damage is limited to my small bile duct, and my extra-hepatic ducts are perfectly clean. My hepatologist told me that it is unlikely that small-duct PSC will become large-duct PSC. However, I don't think they have done very much reasearch yet comparing the two. The few studies that have been done seem promising, in that small- duct PSC is less aggressive, less likely to lead to carcinoma of the liver, and had lower incidences of mortality or necessity of transplant. Here is a medscape article that discusses one of the studies: Good Prognosis for Small Duct Primary Sclerosing Cholangitis Laurie Barclay, MD INFORMATION FROM INDUSTRY Assess clinically focused product information on Medscape. Click Here for Product Infosites – Information from Industry. Nov. 6, 2002 — The natural history of small duct primary sclerosing cholangitis (PSC) is unknown. In a study reported in the November issue of Gut, investigators compared outcomes over eight years in 33 patients with small duct and in 260 patients with large duct PSC. " Patients with small duct PSC seem to have a good prognosis in terms of survival and development of cholangiocarcinoma, " write E. Björnsson, from Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues. " Small duct PSC progresses to large duct PSC in a small proportion of patients. " Subjects in this study were admitted to one center in Oxford, U.K., or to another in Oslo, Norway, for diagnostic workup of cholestatic pattern of elevation in liver function tests. They included 33 patients with small duct PSC, based on histological features of PSC but with a normal cholangiogram, and 260 patients with large duct PSC. Mean age at diagnosis was 38 and 39 years in small duct and large duct PSC, respectively, and mean follow-up was 106 and 105 months, respectively. Of the 33 patients originally diagnosed with small duct PSC, four developed large duct PSC, including two who underwent liver transplantation during follow-up. Of the remaining 29 patients, one died of liver failure and the other died of unrelated cardiac death. Prognosis was worse in the patients with large duct PSC; 122 patients (47%) either required liver transplantation (34 patients) or died (88 patients). Cholangiocarcinoma developed in none of the patients with small duct PSC and in 28 (11%) of 260 patients with large duct PSC. " The results of our study support the lack of association between cholangiocarcinoma and small duct PSC. This suggests that cholangiocarcinoma in PSC is a disease of large duct epithelium and not of small duct epithelium, " the authors write. " In other words, this epithelium is susceptible to the carcinogenetic agent(s) of PSC (whatever it is) while the small epithelium seems to be resistant. Understanding of the nature of this resistance could be of potential therapeutic use. " But, it is something to be taken with caution, because I think the studies are few so far. I know I have seen posts on here from people with small-duct PSC who had theirs progress to become large-duct PSC. Debbie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2009 Report Share Posted January 28, 2009 I have small-duct PSC. They had a hard time diagnosing me, and for awhile thought that I had PBC because the damage is limited to my small bile duct, and my extra-hepatic ducts are perfectly clean. My hepatologist told me that it is unlikely that small-duct PSC will become large-duct PSC. However, I don't think they have done very much reasearch yet comparing the two. The few studies that have been done seem promising, in that small- duct PSC is less aggressive, less likely to lead to carcinoma of the liver, and had lower incidences of mortality or necessity of transplant. Here is a medscape article that discusses one of the studies: Good Prognosis for Small Duct Primary Sclerosing Cholangitis Laurie Barclay, MD INFORMATION FROM INDUSTRY Assess clinically focused product information on Medscape. Click Here for Product Infosites – Information from Industry. Nov. 6, 2002 — The natural history of small duct primary sclerosing cholangitis (PSC) is unknown. In a study reported in the November issue of Gut, investigators compared outcomes over eight years in 33 patients with small duct and in 260 patients with large duct PSC. " Patients with small duct PSC seem to have a good prognosis in terms of survival and development of cholangiocarcinoma, " write E. Björnsson, from Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues. " Small duct PSC progresses to large duct PSC in a small proportion of patients. " Subjects in this study were admitted to one center in Oxford, U.K., or to another in Oslo, Norway, for diagnostic workup of cholestatic pattern of elevation in liver function tests. They included 33 patients with small duct PSC, based on histological features of PSC but with a normal cholangiogram, and 260 patients with large duct PSC. Mean age at diagnosis was 38 and 39 years in small duct and large duct PSC, respectively, and mean follow-up was 106 and 105 months, respectively. Of the 33 patients originally diagnosed with small duct PSC, four developed large duct PSC, including two who underwent liver transplantation during follow-up. Of the remaining 29 patients, one died of liver failure and the other died of unrelated cardiac death. Prognosis was worse in the patients with large duct PSC; 122 patients (47%) either required liver transplantation (34 patients) or died (88 patients). Cholangiocarcinoma developed in none of the patients with small duct PSC and in 28 (11%) of 260 patients with large duct PSC. " The results of our study support the lack of association between cholangiocarcinoma and small duct PSC. This suggests that cholangiocarcinoma in PSC is a disease of large duct epithelium and not of small duct epithelium, " the authors write. " In other words, this epithelium is susceptible to the carcinogenetic agent(s) of PSC (whatever it is) while the small epithelium seems to be resistant. Understanding of the nature of this resistance could be of potential therapeutic use. " But, it is something to be taken with caution, because I think the studies are few so far. I know I have seen posts on here from people with small-duct PSC who had theirs progress to become large-duct PSC. Debbie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 Lori- My son has pericholangitis (small duct PSC) per liver biopsy but has large duct findings per MRCPs, ERCPs, ultrasounds and labs. So I guess he would have mixed PSC or maybe considered classic PSC ?? Sampling error in his liver biopsy has been mentioned by several doctors so maybe it is possible to have both small and large PSC but only find one kind per biopsy ? http://emedicine.medscape.com/article/181889-overview Lori lucky mom blessed with triplets www.caringbridge.org/visit/bradenwild > > How do you know if you have small or large duct PSC? Sounds like it is better to have small duct psc but it also sounds like small duct PSC eventually turns into large duct PSC. Thanks for the good info. > > Lori A. > > > > > > ________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 Lori- My son has pericholangitis (small duct PSC) per liver biopsy but has large duct findings per MRCPs, ERCPs, ultrasounds and labs. So I guess he would have mixed PSC or maybe considered classic PSC ?? Sampling error in his liver biopsy has been mentioned by several doctors so maybe it is possible to have both small and large PSC but only find one kind per biopsy ? http://emedicine.medscape.com/article/181889-overview Lori lucky mom blessed with triplets www.caringbridge.org/visit/bradenwild > > How do you know if you have small or large duct PSC? Sounds like it is better to have small duct psc but it also sounds like small duct PSC eventually turns into large duct PSC. Thanks for the good info. > > Lori A. > > > > > > ________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 Lori- My son has pericholangitis (small duct PSC) per liver biopsy but has large duct findings per MRCPs, ERCPs, ultrasounds and labs. So I guess he would have mixed PSC or maybe considered classic PSC ?? Sampling error in his liver biopsy has been mentioned by several doctors so maybe it is possible to have both small and large PSC but only find one kind per biopsy ? http://emedicine.medscape.com/article/181889-overview Lori lucky mom blessed with triplets www.caringbridge.org/visit/bradenwild > > How do you know if you have small or large duct PSC? Sounds like it is better to have small duct psc but it also sounds like small duct PSC eventually turns into large duct PSC. Thanks for the good info. > > Lori A. > > > > > > ________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 My last biopsy was sent to four different labs to get read because they were having trouble figuring out what they were looking at. It went from my Local hospital to University of land to Pitsburg to MAyo before they came up with Samll duct PSC. There was also two conference calls to find out about the AMA lab results to rule out PBC and another one to discuss possible medication related small duct destruction. I think they even reviewed the MRCP results. I think they also said something about the results of my first biopsy made it a little easier to say that it was PSC because that one showed the " onion skin " markings commonly seen in Large duct and the eosinophil over population, or something like that. What they couldn't explain was why the appearance changed so much in the course of 5 years. SO I guess it can be really hard to figure out when it does not appear from what is known to be typical. Dawn > he would have mixed PSC or maybe considered classic PSC ?? Sampling > error in his liver biopsy has been mentioned by several doctors so > maybe it is possible to have both small and large PSC but only find > one kind per biopsy ? > > http://emedicine.medscape.com/article/181889-overview > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 My last biopsy was sent to four different labs to get read because they were having trouble figuring out what they were looking at. It went from my Local hospital to University of land to Pitsburg to MAyo before they came up with Samll duct PSC. There was also two conference calls to find out about the AMA lab results to rule out PBC and another one to discuss possible medication related small duct destruction. I think they even reviewed the MRCP results. I think they also said something about the results of my first biopsy made it a little easier to say that it was PSC because that one showed the " onion skin " markings commonly seen in Large duct and the eosinophil over population, or something like that. What they couldn't explain was why the appearance changed so much in the course of 5 years. SO I guess it can be really hard to figure out when it does not appear from what is known to be typical. Dawn > he would have mixed PSC or maybe considered classic PSC ?? Sampling > error in his liver biopsy has been mentioned by several doctors so > maybe it is possible to have both small and large PSC but only find > one kind per biopsy ? > > http://emedicine.medscape.com/article/181889-overview > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 My last biopsy was sent to four different labs to get read because they were having trouble figuring out what they were looking at. It went from my Local hospital to University of land to Pitsburg to MAyo before they came up with Samll duct PSC. There was also two conference calls to find out about the AMA lab results to rule out PBC and another one to discuss possible medication related small duct destruction. I think they even reviewed the MRCP results. I think they also said something about the results of my first biopsy made it a little easier to say that it was PSC because that one showed the " onion skin " markings commonly seen in Large duct and the eosinophil over population, or something like that. What they couldn't explain was why the appearance changed so much in the course of 5 years. SO I guess it can be really hard to figure out when it does not appear from what is known to be typical. Dawn > he would have mixed PSC or maybe considered classic PSC ?? Sampling > error in his liver biopsy has been mentioned by several doctors so > maybe it is possible to have both small and large PSC but only find > one kind per biopsy ? > > http://emedicine.medscape.com/article/181889-overview > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 Thanks all for your great imput! I am so thankful for this group and just love it. Lori A. "Aggressively Pursuing Solutions To Your Real Estate Needs!" First Weber Group Cell: 1507 E. Sunset Drive Waukesha, WI 53189 LoriUSA@... www.Lori.FirstWeber.com To: Sent: Thursday, January 29, 2009 8:52:01 AMSubject: Re: Small-duct PSC Lori-My son has pericholangitis (small duct PSC) per liver biopsy but haslarge duct findings per MRCPs, ERCPs, ultrasounds and labs. So I guesshe would have mixed PSC or maybe considered classic PSC ?? Samplingerror in his liver biopsy has been mentioned by several doctors somaybe it is possible to have both small and large PSC but only findone kind per biopsy ?http://emedicine. medscape. com/article/ 181889-overviewLorilucky mom blessed with tripletswww.caringbridge. org/visit/ bradenwild>> How do you know if you have small or large duct PSC? Sounds likeit is better to have small duct psc but it also sounds like small ductPSC eventually turns into large duct PSC. Thanks for the good info.> > Lori A. > > > > > > ____________ _________ _________ __> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 Thanks all for your great imput! I am so thankful for this group and just love it. Lori A. "Aggressively Pursuing Solutions To Your Real Estate Needs!" First Weber Group Cell: 1507 E. Sunset Drive Waukesha, WI 53189 LoriUSA@... www.Lori.FirstWeber.com To: Sent: Thursday, January 29, 2009 8:52:01 AMSubject: Re: Small-duct PSC Lori-My son has pericholangitis (small duct PSC) per liver biopsy but haslarge duct findings per MRCPs, ERCPs, ultrasounds and labs. So I guesshe would have mixed PSC or maybe considered classic PSC ?? Samplingerror in his liver biopsy has been mentioned by several doctors somaybe it is possible to have both small and large PSC but only findone kind per biopsy ?http://emedicine. medscape. com/article/ 181889-overviewLorilucky mom blessed with tripletswww.caringbridge. org/visit/ bradenwild>> How do you know if you have small or large duct PSC? Sounds likeit is better to have small duct psc but it also sounds like small ductPSC eventually turns into large duct PSC. Thanks for the good info.> > Lori A. > > > > > > ____________ _________ _________ __> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2009 Report Share Posted January 29, 2009 Thanks all for your great imput! I am so thankful for this group and just love it. Lori A. "Aggressively Pursuing Solutions To Your Real Estate Needs!" First Weber Group Cell: 1507 E. Sunset Drive Waukesha, WI 53189 LoriUSA@... www.Lori.FirstWeber.com To: Sent: Thursday, January 29, 2009 8:52:01 AMSubject: Re: Small-duct PSC Lori-My son has pericholangitis (small duct PSC) per liver biopsy but haslarge duct findings per MRCPs, ERCPs, ultrasounds and labs. So I guesshe would have mixed PSC or maybe considered classic PSC ?? Samplingerror in his liver biopsy has been mentioned by several doctors somaybe it is possible to have both small and large PSC but only findone kind per biopsy ?http://emedicine. medscape. com/article/ 181889-overviewLorilucky mom blessed with tripletswww.caringbridge. org/visit/ bradenwild>> How do you know if you have small or large duct PSC? Sounds likeit is better to have small duct psc but it also sounds like small ductPSC eventually turns into large duct PSC. Thanks for the good info.> > Lori A. > > > > > > ____________ _________ _________ __> Quote Link to comment Share on other sites More sharing options...
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