Primary Sclerosing Cholangitis PSC describes a disease process in which the bile ducts in the liver become inflamed, narrow and prevent bile from flowing properly.
The liver produces bile to help digest food in the intestine. Bile from liver cells is transported through the bile ducts in the biliary tree, where it then enters the gallbladder. When food enters the small intestine, bile helps break down fat into fatty acids so that they can be absorbed and used by the body. Bile also helps in the absorption of fat-soluble vitamins (A, D, E & K).
As the bile ducts become inflamed and narrow, bile cannot easily flow and begins to back up. This increases the pressure within the liver causing liver cells to become inflamed. Over time, this inflammation decreases blood flow within the liver, increasing the pressure in the portal vein. This eventually causes portal hypertension, a backup in the portal system causing veins that line the esophagus, stomach, and intestine to swell (varices) and the spleen to swell (splenomegaly).
As the disease progress, liver cells die and are replaced by scar tissue. This is called cirrhosis and is associated with liver failure.
Symptom
Itching
Depending upon the underlying cause, itchiness may be associated with other symptoms and signs. Most
commonly, these associated findings include skin lesions such as rash, blisters, bumps, or redness of the affected area. Dryness of the skin is a common cause of itch.
Itching of skin can lead to tears in the skin (excoriations) from scratching. Less commonly, generalized itching all over the body can be a sign of chronic medical conditions such as liver disease. In these situations, there may be no changes to the appearance of the skin.
What causes Primary Sclerosing Cholangitis PSC?
The cause of Primary sclerosing cholangitis (PSC) is unknown but it has an association with inflammatory bowel disease, especially ulcerative colitis.
Some research thought that there may be an autoimmune component to the disease, where the body’s immune system attacks the bile ducts in the liver and causes them to become, inflamed and narrowed but I (Dr. Qaisar Ahmed) am not agreeing with them, and cous of it you will find in the end in treatment section.
What are the risk factors for Primary Sclerosing Cholangitis PSC?
Primary sclerosing cholangitis (PSC) is more often seen in men in the 20-30 years age range. There is an association with inflammatory bowel, disease, most often with ulcerative colitis and less commonly with Crohn’s Disease.
People with Primary sclerosing cholangitis (PSC) who do not have inflammatory bowel disease, are more likely to be female and older.
What are Primary Sclerosing Cholangitis PSC symptoms and signs?
In its early stages, Primary sclerosing cholangitis (PSC) is asymptomatic (there are no symptoms). It is only when the person develops cholestasis because of the inability of bile to drain from the liver, do symptoms occur.
These early symptoms include itching and fatigue. As the bilirubin levels in the blood become elevated, jaundice or a yellowish tinge to the skin, may occur. Since there may be liver inflammation, the patient may complain of pain beneath the ribs in the right upper quadrant of the abdomen.
The inability of the bile ducts to adequately drain reduces the flow of bile and there can be sludge formation in the bile ducts leading to the risk of infection. This may cause fever and increased pain.
Because Primary sclerosing cholangitis (PSC) is a progressive disease, symptoms may come and go over several months and years after the diagnosis is made.
As the disease progresses, cirrhosis may occur leading to decreased liver function and its associated signs and symptoms. These include bleeding from the esophagus and stomach due to varices, ascites (fluid collection in the abdomen) because of poor protein production by the liver, easy bruising because of decreased platelets in the blood as because they are trapped in the enlarged spleen, and confusion due to hepatic encephalopathy because the liver cannot clear waste products of metabolism.
Diagnosis of Primary Sclerosing Cholangitis PSC
Primary sclerosing cholangitis (PSC) may remain silent for several years before symptoms arise. In patients with inflammatory bowel disease, the health care professional should have a high suspicion of the diagnosis because of the relationship between PSC and ulcerative colitis.
Depending upon how far the disease has progressed and the effect on liver function, physical examination may reveal an enlarged liver, tenderness in the right upper quadrant beneath the ribs, and an enlarged spleen. The skin may be jaundiced or yellow and there can be evidence of scratching due to intense skin itching. In cirrhosis with end stage liver disease, there may be bruising of the skin, a swollen abdomen due to ascites or fluid caused by decreased protein production and decreased blood flow through the scarred liver, gastrointestinal bleeding, and mental confusion because of elevated ammonia levels in the bloodstream.
Blood tests are helpful in assessing the liver and potential blockages within the bile ducts. These may include a complete blood count, INR/PTT (that measures blood clotting and the ability of the liver to produce clotting factors), liver function studies including AST, and ALT to assess liver inflammation, alkaline phosphatase and bilirubin which measure the degree of bile blockage.
Imaging tests may include ultrasound to look at the liver structure and magnetic resonance cholangiogram, an MRI of the abdomen that can assess the bile duct structure of the liver.
If the diagnosis based on laboratory tests and imaging is still in doubt, a biopsy may be performed.
What is the treatment for Primary Sclerosing Cholangitis PSC?
Allopathic Treatment:
The allopathic treatment of Primary sclerosing cholangitis (PSC) is supportive, monitoring the progression of the
disease and treating symptoms and complications as they arise. The only “cure” in allopathic medicine is liver transplantation, which may be an option when the disease progresses to cirrhosis and the liver function is affected.
When some of the larger bile ducts become blocked, there is potential to open them with ERCP (endoscopic retrograde cholangiopancreatography) and balloon dilatation and/or stent placement. A gastroenterologist passes a thin video endoscope into the mouth and threads it through the stomach into the duodenum and using a catheter, enters the bile ducts. Should a narrow duct or stricture be found, a balloon can be used to dilate the narrowing and a stent can be placed to keep the duct open. This is similar to how a cardiologist opens a blocked blood vessel in the heart
In some cases, surgery may be an option to remove some scarred and blocked bile ducts and having more normal bile ducts reconnected bypassing scarred areas of the bile ducts.
Medications
There is no allopathic medication that is approved to treat primary sclerosing cholangitis, but medications may be used to control symptoms. Ursodiol (Actigal), also known as ursodeoxycholic acid (UDCA), may improve liver function tests but has not been shown to increase survival and may be associated with complications like bleeding. While it is thought that PSC may be an autoimmune disease, immunosuppressive medications have not been shown to work.
Itching is often treated with antihistamines including diphenhydramine (Benadryl), hydroxyzine (Atarax) and cyproheptadine (Periactin). Cholestyramine (Questrom, Questrom Light), a medication that helps bind bile salts may also be helpful. Should infection occur, treatment may require antibiotics.
As the disease progresses, the damaged liver may not be able to help with the absorption of vitamins and nutrients from the intestine. Vitamins and other dietary and calorie supplements may be required to treat malnutrition.
Liver transplant
Liver transplant is the only “cure” for primary sclerosing cholangitis, but it is only recommended for patients whose disease has progressed to liver failure. The three-year U.S. survival rate for all transplants is 81%. The five-year survival rate is about 75%, according to the data from the Scientific Registry of Transplant Recipients.
The goal of liver transplantation is to restore liver function. Though unlikely, it is possible for PSC to recur in the new liver.
Proper Homeopathic Treatment of Primary Sclerosing Cholangitis PSC
Cardus Marianus
The action of Cardus Marianus is centered in the liver, and portal system, causing soreness, pain, jaundice. Has specific relation to the vascular system. Abuse of alcoholic beverages, especially beer. Varicose veins and ulcers. Diseases of miners, associated with asthma. Dropsical conditions depending on liver disease, and when due to pelvic congestion and hepatic disease. Disturbs sugar metabolism. Influenza when liver is affected. Debility. Hemorrhages, especially connected with hepatic disease, dropsical accumulation of water in abdomen (ascites).
The next field is bleeding consequent to liver damage, liver pain and sensitiveness, feel fatigued or tired and have bouts of nausea and vomiting due to Liver Cirrhosis. Taste bitter. Aversion to salt meat. Appetite small; tongue furred; nausea; retching; vomiting of green, acid fluid. Stitches in left side of stomach, near spleen (Ceanothus). Gallstone disease with enlarged liver.
Pain in region of liver. Left lobe very sensitive. Fullness and soreness, with moist skin. Constipation; stools hard, difficult, knotty; alternates with diarrhea. Stools bright yellow. Swelling of gallbladder with painful tenderness. Hyperemia of liver, with jaundice. Cirrhosis, with dropsy.
Rectum: Hemorrhagic piles, prolapse or rectum, burning pain in anus and rectum, hard and knotting, clayey stools. Profuse diarrhea due to rectal cancer. 10 drops doses (Wapler).
Urine: Cloudy; golden-colored.
Skin: Itching on lying down at night. Varicose ulcers (Clematis vitalba). Eruption on lower part of sternum.
Extremities: Pain in hip-joint, spreading through buttocks and down thigh; worse from stooping. Difficult rising. Weakness felt in feet, especially after sitting.
Belladonna
Belladonna acts upon every part of the nervous system, producing active congestion, furious excitement, perverted special senses, twitching, convulsions and pain. It has a marked action on the vascular system, skin and glands. Belladonna always is associated with hot, red skin, flushed face, glaring eyes, dryness of mouth and throat with aversion to water, neuralgic pains that come and go suddenly (Oxytropis), Spasmodic pain in epigastrium. Constriction: pain runs to spine. Nausea and vomiting. Great thirst for cold water. Spasms of stomach. Empty retching. Abhorrence of liquids. Spasmodic hiccough. Dread of drinking. Uncontrollable vomiting.
Abdomen: Distended, hot. Transverse colon protrudes like a pad. Tender, swollen. Pain as if clutched by a hand; worse, jar, pressure. Cutting pain across; stitches in left side of abdomen, when coughing, sneezing, or touching it. Extreme sensitiveness to touch.
Stools: Thin, green, dysenteric; in lumps like chalk. Shuddering during stool. Stinging pain in rectum; spasmodic stricture. Piles more sensitive with backache. Prolapses anis.
Urine: Retention. Acute urinary infections. Sensation of motion in bladder as of a worm. Urine scanty, with tenesmus; dark and turbid, loaded with phosphates. Vesical region sensitive. Incontinence, continuous dropping. Frequent and profuse. Hematuria where no pathological condition can be found. Prostatic hypertrophy.
Chelidonium Majus
A prominent liver remedy, covering many of the direct reflex symptoms of diseased conditions of that organ. The jaundiced skin, and especially the constant pain under inferior angle of right scapula, are certain indications. Paralytic drawing and lameness in single parts. The great general lethargy and indisposition to make any effort is also marked. Ailments brought on or renewed by change of weather. Serous effusions. Hydrocele. Bilious complication during gestation.
Tongue yellow, with imprint of teeth; large and flabby (Merc; Hyd). Taste bitter, pasty. Bad odor from mouth. Prefers hot food and drink. Nausea, vomiting; better, very hot water. Pain through stomach to back and right shoulder-blade. Gastralgia. Eating relieves temporarily, especially when accompanied with hepatic symptoms.
Abdomen: Jaundice due to hepatic and gall-bladder obstruction. Gall-colic. Distention. Fermentation and sluggish bowels. Constriction across, as by a string. Liver enlarged. Gallstones (Berberis).
Urine: Profuse, foaming, yellow urine, like beer (Chenop) dark, turbid.
Stool: Constipation; stools hard, round balls, like sheep’s dung, bright yellow, pasty; clay-colored, stools float in water; alternation of diarrhea and constipation. Burning and itching of anus.
Skin: Dry heat of skin; itches, yellow. Painful red pimples and pustules. Old, spreading, offensive ulcers. Wilted skin. Sallow, cold, clammy.
Pain in nape. Stiff neck, head drawn to left. Fixed pain under inner and lower angle of right scapula. Pain at lower angle of left scapula. Pain in arms, shoulders, hands, tips of fingers. Icy coldness of tips of fingers; wrists sore, tearing in metacarpal bones. Whole flesh sore to touch. Rheumatic pain in hips and thighs; intolerable pains in heels, as if pinched by too narrow a shoe; worse, right. Feels paralyzed. Paresis of the lower limbs with rigidity of muscles.
Lycopodium
Corresponds to Grau ogle’s carbo-nitrogenous constitution, the non-eliminative lithaemic. Lycopodium is adapted more especially to ailments gradually developing, functional power weakening, with failures of the digestive powers, where the function of the liver is seriously disturbed. Atony. Malnutrition. Mild temperaments of lymphatic constitution, with catarrhal tendencies; older persons, where the skin shows yellowish spots, earthy complexion, uric acid diathesis, etc; also precocious, weakly children.
Dyspepsia due to farinaceous and fermentable food, cabbage, beans, etc. Excessive hunger. Aversion to bread, etc. Desire for sweet things. Food tastes sour. Sour eructation. Great weakness of digestion. Bulimia, with much bloating. After eating, pressure in stomach, with bitter taste in mouth. Eating ever so little creates fullness. Wakes at night feeling hungry. Hiccough. Incomplete burning eructation rise only to pharynx there burn for hours. Likes to take food and drink hot. Sinking sensation; worse night. kidney affections, red sand in urine, pain in renal region; worse before urination. Intolerant of cold drinks. Best adapted to persons intellectually keen, but of weak, muscular power.
Deep-seated, progressive, chronic diseases. Carcinoma. Emaciation. Debility in morning. Marked regulating influence upon the glandular (sebaceous) secretions. Pre-senility. Ascites lacks vital heat (immune system); has poor circulation, cold extremities. Pains come and go suddenly. Sensitive to noise and odors. Cirrhosis of Liver when the liver has atrophied due to long-standing Cirrhosis. Hepatitis may be predominantly present.
Abdomen is bloated, full. Constant sense of fermentation in abdomen, like yeast working; upper left side. Hernia, right side. Liver sensitive. Brown spots on abdomen. Dropsy, due to hepatic disease. Hepatitis, atrophic from of nutmeg liver.
Stool: Diarrhea. Inactive intestinal canal. Ineffectual urging. Stool hard, difficult, small, incomplete. Hemorrhoids; very painful to touch, aching.
Urine: Pain in back before urinating; ceases after flow; slow in coming, must strain. Retention. Polyuria during the night. Heavy red sediment.
Arsenic Album
A profoundly acting remedy on every organ and tissue. Its clear-cut characteristic symptoms and correspondence to many severe types of disease make its homeopathic employment constant and certain.
Liver Cirrhosis with fatigue as the main symptom. The patient feels totally exhausted from doing a little labor. Cannot bear the sight or smell of food. Great thirst; drinks much, but little at a time. Nausea, retching, vomiting, after eating or drinking. Anxiety in pit of stomach. Burning pain. Craves acids and coffee. Heartburn: gulping up of acid and bitter substances which seem to excoriate the throat. Long-lasting eructation. Vomiting of blood, bile, green mucus, or brown-black mixed with blood. Stomach extremely irritable; seems raw, as if torn. Gastralgia from slightest food or drink. Dyspepsia from vinegar, acids, ice-cream, ice-water, tobacco. Terrible fear and dyspnea, with gastralgia; also, faintness, icy coldness, great exhaustion. Malignant symptoms. Everything swallowed seems to lodge in the oesophagus, which seems as if closed and nothing would pass. Ill effects of vegetable diet, melons, and watery fruits generally. Craves milk.
Gnawing, burning abdominal pains; relieved by heat. Liver and spleen enlarged and painful. Ascites and anasarca. Abdomen swollen and painful. Pain as from a wound in abdomen on coughing.
Rectum: Painful, spasmodic protrusion of rectum. Tenesmus. Burning pain and pressure in rectum and anus.
Stool: Small, offensive, dark, with much prostration. Worse at night, and after eating and drinking; from chilling stomach, alcoholic abuse, spoiled meat. Dysentery dark, bloody, very offensive. Cholera, with intense agony, prostration, and burning thirst. Body cold as ice (Verat). Hemorrhoids burn like fire, relieved by heat. Skin excoriated about anus.
Urine: Scanty, burning, involuntary. Bladder as if paralyzed. Albuminous. Epithelial cells; cylindrical clots of fibrin and globules of pus and blood. After urinating, feeling of weakness in abdomen. Bright’s disease. Diabetes.
Nux Vomica
Nux Vomica is greatest of polychrest. Liver Cirrhosis who has a history of long-term alcoholic abuse, chronic acidity and constipation. Sour mouth taste, and nausea in the morning, after eating. Weight and pain in stomach; worse, eating, sometime after. Flatulence and pyrosis. Sour, bitter eructation. Nausea and vomiting, with much retching. Ravenous hunger, especially about a day before an attack of dyspepsia. Region of stomach very sensitive to pressure. Epigastrium bloated, with pressure s of a stone, loves fats and tolerates them well. Dyspepsia from strong tea and/or coffee. Difficult belching of gas. Wants to vomit but cannot. soreness or stitching pain in liver region.
Inclination to take highly spicy diet, stimulants (tea, coffee, alcoholic drinks and fat etc). Mentally anger some and irritable nature, being sensitive to external impressions like noise and odor and also, a sensitivity to cold air.
Bruised soreness of abdominal walls. Flatulent distension, with spasmodic colic. Colic from uncovering. Liver engorged, with stitches and soreness. Colic, with upward pressure, causing short breath, and desire for stool. Weakness of abdominal ring region. Strangulated hernia. Forcing in lower abdomen towards genitals. Umbilical hernia of infants.
Stool: Constipation, with frequent ineffectual urging, incomplete and unsatisfactory; feeling as if part remained un-expelled. Constriction of rectum. Irregular, peristaltic action; hence frequent ineffectual desire, or passing but small quantities at each attempt. Absence of all desire for defecation is a contra-indication. Alternate constipation and diarrhea-after abuse of purgatives. Urging to stool felt throughout abdomen. Itching, blind hemorrhoids, with ineffectual urging to stool; very painful; after drastic drugs. Diarrhea after a debauch; worse, morning. Frequent small evacuations. Scanty stool, with much urging. Dysentery: stools relieve pains for a time. Constant uneasiness in rectum. Diarrhea, with jaundice.
Urine: Irritable bladder; from spasmodic sphincter. Frequent calls; little and often. Hematuria. Ineffectual urging, spasmodic and strangury. Renal colic extending to genitals, with dribbling urine. While urinating, itching in urethra and pain in neck of bladder.
Phosphorus
Phosphorus is a destructive metabolism. Causes yellow atrophy of the liver and sub-acute hepatitis, jaundice in patients with Cirrhosis of Liver, stool very offensive, vomiting of blood, desire for cold drinks, juices and ice creams.
Hunger soon after eating. Sour taste and sour eructation after every meal. Belching large quantities of wind, after eating. Throws up ingesta by the mouthfuls. Vomiting: water is thrown up as soon as it gets warm in the stomach. Postoperative vomiting. Cardiac opening seems contracted, too narrow; the food scarcely swallowed, comes up again. Pain in stomach; relieved by cold food, ices. Region of stomach painful to touch, or on walking. Inflammation of stomach, with burning extending to throat and bowels. Bad effects of eating too much salt.
Abdomen feels cold. Sharp, cutting pains. A very weak, empty, gone sensation felt in whole abdominal cavity. Liver congested. Acute hepatitis. Fatty degeneration (Carbon tetrachloride; Ars. Chlorof). Jaundice. Pancreatic disease. Large, yellow spots on abdomen.
Stool: Very fetid stools and flatus. Long, narrow, hard, like a dog’s and difficult to expel. Desire for stool on lying especially on left side. Painless, copious debilitating diarrhea. Green mucus with grains like sago. Involuntary; seems as if anus remained open. Great weakness after stool. Discharge of blood from rectum, during stool. White, hard stools. Bleeding hemorrhoids.
Urine: Hematuria, especially in acute Bright’s disease. Turbid, brown, with red sediment.
Apocynum Cannabinum
Increases secretions of mucous and serous membranes and acts on cellular tissue, reducing oedema and dropsy.
Nausea, with drowsiness. Thirst on walking. Excessive vomiting. Food or water is immediately ejected. Dull, heavy, sick feeling. Oppression in epigastrium and chest, impeding breathing (Lobelia infl). Sensation of sinking in stomach. Abdomen bloated. Ascites.
Stool: Watery, flatulent, with soreness in anus; worse after eating. Feeling as if sphincter were open and stools ran right out.
Urine: Bladder much distended. Turbid, hot urine, with thick mucus and burning in urethra, after urinating. Little expulsive power. Dribbling. Strangury. Renal Dropsy.
Quassia Amara
Acts on gastric organs as a tonic. Seems to possess marked action on eyes, producing amblyopia and cataract. Pain in right intercostal muscles above the liver. Pressure and stitches in liver, and sympathetically in spleen.
Stomach: Atonic dyspepsia, with gas and acidity. Heartburn and gastralgia. Regurgitation of food. Abdomen feels empty and retracted. Dyspepsia after infectious diseases; especially grip, dysentery. Tongue dry or with brown sticky coating. Cirrhosis of liver with ascites.
Urinary: Excessive desire-impossible to retain urine; copious micturition day and night. As soon as the child wakes up the bed is drenched.
Inclination to yawn and stretch. Sensation of coldness over back. Prostration, with hunger. Cold extremities, with sensation of internal coldness.
Complications
Primary sclerosing cholangitis (PSC) is a progressive disease, damaging the bile ducts and reducing the/cat-playing-with-little-gerbil-mouse-on-thetable-507209918-5aa963921f4e1300371a3099.jpg)
bile flow, ultimately leading to portal hypertension, cirrhosis, and liver failure.
Some cancers are associated with primary sclerosing cholangitis including gallbladder cancer, hepatocellular cancer (cancer of the liver cells) and cholangiocarcinoma (cancer of the bile ducts). The combination of inflammatory bowel disease and PSC increases the risk of developing cancers of the colon and rectum.
What is the prognosis and life expectancy for a person with Primary sclerosing cholangitis (PSC)?
Aside from liver transplantation, Homeopathy is an effective treatment for Primary sclerosing cholangitis (PSC), the treatment duration is almost 3-6 months deepening on the stage and life style of the patient.
P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).
For proper consultation and treatment, please visit our clinic.
None of above-mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.
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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.
Senior research officer at Dnepropetrovsk state medical academy Ukraine.
Location: Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.
Find more about Dr Sayed Qaisar Ahmed at:
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