A 36-year-old nurse with a 15-year history of ulcerative colitis (UC) develops abnormal liver enzymes. ALT 154 U/l, alkaline phosphatase 354 U/l, bilirubin 12 mmol/l. An ultrasound is normal. She is antineutrophil cytoplasmic antibody (ANCA)-positive. What would you be most likely to suspect?
2. Mesalazine hepatitis
3. Primary sclerosing cholangitis
4. Chronic active hepatitis
5. Primary biliary cirrhosis
Correct Answer 3
Primary sclerosing cholangitis Primary sclerosing cholangitis (PSC) classically occurs with inflammatory bowel disease especially ulcerative colitis and is associated with a high risk of cholangiocarcinoma and colon cancer.