Primary Sclerosing Cholangitis: Visual Explanation for Students

This video contains a detailed and simplified explanation about primary sclerosing cholangitis aimed at the level of a medical student level and above.
We cover the pathophysiology, presentation, diagnosis, complications and management of primary sclerosing cholangitis.
More written notes and diagrams about primary sclerosing cholangitis are available on the website at www.zerotofinals.com/primarysclerosingcholangitis
Special thanks to Harry Watchman for editing the audio in this video.
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DISCLAIMER: This video is for education and entertainment only, and is not medical advice. This video should NOT be used for medical advice or to guide clinical practice. The Zero to Finals content should not be used in any way to guide medical decision making. Zero to Finals takes no responsibility for any actions taken or not taken based on the information provided. Local and national guidelines and senior clinicians are there to help you make decisions, not KZbin videos. If you need medical advice or information, seek it from an appropriately trained and licenced doctor or healthcare provider that can address your individual needs. Zero to Finals cannot guarantee the accuracy of information in this video. Please highlight any errors you notice in the comments below - thank you.

[@matthewfritz8026]

I am a 13 year old boy who got diagnosed with PSC several months ago. This video helped give me clarity as to what's going on. No history of liver diseases in my family. It began with a continuous fever that lasted three weeks getting up to 103.5°f. I spoke with my GP and I got recommended to a GI. After the fact, I got a recommendation for an admission that lasted over a week. I have had one ERCP in which they couldn't successfully get through to the proper area. I also had a liver biopsy done. After medication from the past few months, several blood tests were abnormal. I will be having a second biopsy in the upcoming months to understand what's going on. I pray that anyone going through a similar situation can be introduced into the love of Jesus Christ. Times can be hard, but He will be there to support you, He will be there to love you, and He will be there to help you get through those rough times. I pray that He be with you. God bless you.

[@Eros13adios]

I pray that there's a Liver Transplant for you 🙏 because you're so young and should be given priority.

[@DanWeglinski]

I was diagnosed around the same age. Also have ulcerative colitis. No family history of it from anyone else. I was lucky and the treatments and doctors kept me in good shape for about 20 years. I had a transplant about 5 and a half years ago. The time leading up to the transplant as you get sicker is scary and difficult, but the relief afterwards is incredible. Good luck with your treatment and eventual transplant, and I pray that all goes as smoothly as possible for you. This can be beaten, and you can have a long and wonderful life

[@ProphetofProfit]

@@DanWeglinski I just got told the news today from my close life long friend that he has PSC at 20 years old. I can’t imagine what he is thinking/going through, but personally for me it’s giving me a ton of anxiety thinking about it. It’s reassuring to hear your kind words, both of you are very strong people. I am sending my prayers out before I go to bed tonight.

[@LouisaWatt]

God bless you too 💚

[@elleseller3348]

@@DanWeglinski hi , I have a family member going through the same situation. They are on the transplant list. Any advice? Any particular treatment you found helpful as you waited for a new liver?

[@reasonjo]

Great video, thank you. I'm not a medical student, but it was easy to follow and understand. I'm 48 and was diagnosed with PSC yesterday. Aside from elevated liver function tests over 6 or 7 years I have no other symptoms, no pain, no excessive itching.. Based on what I have read online in the last 24 hours and this video and its comments, I'm very fortunate.

[@Moonlightmeme1]

Thank you for this video!! My husband was diagnosed with PSC, and I have been reading and reading to find information about this dis-ease. Thank you for breaking it down!

[@fatima3590]

Definition 0:28 Pathophysiology 0:53 Causes 1:43 Clinical presentation 2:39 Investigations 3:03 To establish diagnosis 4:40 Complications 5:03 Management 5:51 - ERCP 6:55

[@hellsworld1]

I am literally the rarity in the world because I got diagnosed with PSC at 16, I'm a female and there's no history of any- none at all- of liver diseases in my family. I am just somehow really, really unlucky and I'm currently on a liver waiting list. Already at 3 ERCPs and my next one is in a few days to remove the stent (they don't last longer than 3 months so you need them changed often). And yeah, everything is shown and said here was spot on with what I've learned this past 4 years.

[@senaaksel5386]

Hope you will find a liver and get well

[@roziyasin6650]

I prey for you Allah is bigger than every thing trust him , just don’t be hopeless

[@mermanshahi]

Be strong….

[@ahmedsharaf2695]

How are now? I hop well

[@hellsworld1]

@@ahmedsharaf2695 I am better! I got my transplant liver and it's hard to keep up with the meds but I'm much much better! Thank you!

[@dangmateo00]

This video is really helpful in understanding the basics of this condition. I’m glad I dropped by to see your illustration. Keep up the good work and thank you so much for sharing your expertise. God bless you.

[@ZeroToFinals]

Thanks!

[@hatducky8691]

I'm a 13 year old american girl who has PSC. It was discovered when I was 12, and even after the doctors had explained it to me, I was still confused. So I looked it up, and found this. Thank you

[@pchou]

if you don't mind sharing. How did they found out? did they just screened you? family history? feel free to DM as it's quite personal.

[@hatducky8691]

@@pchou Years of blood tests and a lot of scans, yeah. I don't even have any family history of it.

[@pchou]

@@hatducky8691 I hope all the best for you, :/ hopefully we find a cure soon.

[@biancajade728]

I have PBC & PSC early stage , but late stage symptoms. Too sick to work(especially now), but not sick enough for disability. I was given a transplant dr already.

[@KSMGaming]

I am 18 and I was diagnosed with UCPSC (ulcerative colitis with primary sclerosing cholangitis). I was diagnosed around a year ago and it is getting worse. I’m not sure how a liver transplant will go with my body in its current state, im unable to do a lot of things like exercise, get much sunlight, or really go a few hours without immense pain. I just hope that for anything else out there with this disease or something like it doesn’t have to go through this. Times are tough and life is extremely unfair and you will come to realise this. But your mentality and the love of those around you will keep you going, at least that’s what keeps me going. A lot of PSC let alone UCPSC patients suffer from depression as well (around 1/3) in my case I don’t have any signs of these though and I would confidently say it’s mainly because of my girlfriend and my friends and family sticking with me

[@alexlouw3485]

I have the same as you

[@tomonabudget]

I'm in the exact category mentioned in this video. I hope for you that you manage to get a transplant and that your body will accept it well so that you can enjoy a very long and happy life!

[@stanleycates1972]

Very informative. With my GB removed a year ago and an attack of pain and chills followed the next day by itching everywhere and some jaundice I suspect some biliary restriction. Will see docs soon after ER visit. Sonogram says liver and pancreas unremarkable. At 85 things are wearing out.

[@merrywhiterose]

I'm a female & was diagnosed with PSC 2 yrs. ago when I was 60. I had a stricture of the common bile duct, which was found while getting my gallbladder removed, about 20 yrs. ago. At that time most drs. didn't know anything about PSC. Survival depends on how advanced the disease is. If there's a full blockage, it's a trip to the ER for an emergency ERCP with stent placement. I had a full blockage. I ended up in the ICU due to sepsis & dehydration. Sepsis is a common problem with PCP as the inflammation & blockages of the bile ducts can cause bile to reverse back into the liver. Common problems are itching, fever with chills, upper R abdominal pain & FATIGUE. Getting a liver transplant isn't always a cure, because it can reoccur in the new liver. Survival rate without a new liver depends on how advanced the cirrhosis is. It's common to require a liver within 10 yrs. of diagnosis. Most people can't get a liver transplant after the age of 70. In that case they end up dying.

[@gregorymalchuk272]

I'm interested in the fatigue aspect of PSC.

[@dannylyons824]

@Chelsea Joseph have you got jaundice yellow eyes? I was 19 when got diagnosed I'm twice that age now and I've gone down hill abit this year been having all the camera jobs and liver biopsy this week see how bad it is now. My bloods all over place my eyes gone more yellow, itching more, and going toilet like 3-4 times a day which never has happened but getting bit worried now but great doctors have me as there first priority. Update 3/8/20 now on steroids to halt the inflammation in my bowels feel great been in them but liver cirroshis I have early stage and not aloud drink anymore!

[@jekku4688]

As someone who is on the verge of possibly being diagnosed with PSC this was very helpful thank you. I am a 60 year woman so it sounds like I am not the typical PSC patient...not sure what that means but we'll see if it progresses.

[@dudebromisterjake]

I'm a 35 year old woman and was just diagnosed this week. I've already developed cirrhosis and I'm on a transplant list, but I'm recovering well from the acute liver failure that landed me at a diagnosis that explains the strange laundry list of symptoms I've been experiencing over half of my life now (basically everything this video lists). Even still, my hepatologist told me it could be a very long time before I need a transplant, and there's no reason I can't continue to live my life. I hope that helps... Best wishes to you, take care of yourself.

[@MattSezer]

It's sad that it's so rare of a disease that a video like this would only be made to explain it to med students who far outnumber the people who actually have the disease.

[@michelfrank8547]

@Chelsea Joseph I'm sorry to hear that. I was diagnosed 2 Years ago when i was 18.

[@mosesadejoh5322]

Highly informative/educative, may God bless you the works of your hands...

[@reem_ebrahim]

brilliant illustrations, thanks a lot!

[@SHAMSUL477]

Wonderful video to learn PSC quickly...

[@dinayounis6473]

thank you. i almost addicted this content.

[@imila1295]

Aww I really love your illustrations.Your vedios help me a lot to clear my concepts throughout.Thank you😍

[@ZeroToFinals]

Awesome, so glad you like them

[@mohammadwattad1882]

awesome explanation

[@5avt0]

I got diagnosed with PSC in 2009. Nothing really happened to me until I turned 12. Began to itch all over my skin very badly, went to the hospital every five to six months. When I became 13 I started going to the hospital about every three months because my stomach would have the worst immense pain I ever felt and it got worse and worse to the point every month I had to go. When I became 14, I would go to the hospital almost every month for the exact same reason. Another thing I'd like to mention for these visits that they were a week long also, it really broke me down. Anyways, I got a liver transplant in 2021 and it was great. It literally made me feel so much better, however the visit was extremely bad, nothing against the staff it was my health at the time because my body was reacting to the new foreign organ that was given to me. At first I would think it would take a day or two to recover and go home but nope it was a month, I began to have a very bad fever along with my stomach being bloated, ended up going to the ICU with a feeding tube because I couldn't drink or eat at all because of how bloated it was, and they drugged me at the same time. I'm pretty sure they overdosed me because I was hallucinating stuff like cartoon characters. They put a drain somewhere between my stomach and leg to see if it'll lower but ended up being blood. They first brought me to a ultrasound to see what's going on, and it turns out I was bleeding somewhere in my body. They called a RRT on me and I went to the ICU. I woke up with a machine through my mouth where I couldn't talk at all and couldn't feel like to breathe but I really did, I panicked so badly they put a drug through one of my IVs to put me to sleep for a bit. Woke up in the ICU blurry for at-least a few hours then it went away. I had to get another surgery to open up my body and see where I was bleeding, that was fixed. At that point because of that, I was so weak to the point I would be in so much pain at the surgical wound if I attempted to get up at all. When I was able to my legs were so weak that I would be trembling like I was about to fall. Few days later they take it off the drain and I ended up having body fluid go out all over my bed for at-least one day, then they put stitches over it for it to stop. I'm gonna be honest I don't remember everything about it but this is what I do remember. Yeah, it sucked, and I still remember the IV and heart rate alarms going off through the ICU.

[@thibosciarrotta1871]

hey man sorry to here that! i got diagnosed today and i probably will need to have a new liver as well, its hard to accept this. How are you doing now?

[@5avt0]

@@thibosciarrotta1871 Hey thanks, it may be way different for you but yeah. I'm doing way better now and all I do is take a lot of medication to prevent my liver from rejecting. I hope you get better soon and I wish you the best of luck!

[@vishavajitsingh2865]

Awesome explanation of the topic .one of the best video .💯💯💯💯

[@ZeroToFinals]

Thanks!

[@marieeysackers527]

Very clear and simple, you're great!

[@ZeroToFinals]

thanks you

[@lubnashehadeh7392]

شكراً لك!!

[@bensmart121]

Very helpful videos as I get ready for USMLE exam!

[@ZeroToFinals]

Good luck!

[@PSCSupportOnline]

Great explanation of PSC!

[@brothersmind3415]

Wonderful lectures.keep going Sir.need many more.

[@GORD444]

I have crohns disease and psc. Honestly kind of scary. Im 19

[@sameddonater]

Dont worry I was also diagnosed with 19 with PSC and Ulcerative Colltis And I don’t have any symptoms because I take my medicines (Urso and Nor-Urso) everyday. Ulcerative colitis is a little bit more challenging for me but since I am doing prolonged and intermittent fasting I feel a lot better

[@K97Gamingg]

Amazing video about disease but i have a comment (risk factor) i think Primary biliary cholangitis is most frequently a disease of women and occurs between the fourth and sixth decades of life .

[@aliciajonker145]

I think you mean Primary Biliary Cirrhosis: a different disease, with very similar symptoms

[@gulsheereen8513]

Thank you sir ❤

[@freeone2748]

Good and simple explanation. thank you.

[@ekaterinaisaeva7404]

Amazing video, thank you so much!

[@marshmallow1488]

I had a positive MRCP, sent to a hepatic specialist and had another MRCP. The hepatic specialist states probably scar tissue and to just watch it. My liver hurts and enzymes are elevated but I also have NAFLD and UC. I hope the specialist is correct.

[@tridocs6253]

its v helpfull..... make more vedioes like this...... especially on GI tract...

[@drbeyzabercin]

That's just perfect!

[@johana9537]

Great Video!! Made annotating the book very interactive :)

[@ZeroToFinals]

awesome! I can't wait to get to work on more

[@petyailieva4794]

Awesome explanation! It helps me a lot! Thank You :)

[@ZeroToFinals]

No problem, glad to help Petya

[@MukeshBK-ru1pf]

what a explanation thank you so much for a such

[@lolololo9672]

Thanks very much for informations 💜💜💜💜

[@pianoliza9051]

Very helpful thank you But where can I have the written notes?

[@lanresaxs5095]

Thank you very much!!!

[@mahamahdi469]

Thank you! i love these video's

[@sunitaprajapati7827]

very nice explanation

[@osamaomar2228]

Thanks a lot, very helpful

[@mah5688]

Thanks

[@karthikjangiti3067]

Excellent

[@phallyun5751]

Very good.

[@naz674]

Awesome video 😍

[@ematurcas8206]

Very helpful!! Thank you!

[@ZeroToFinals]

Glad you like it!

[@dr.dodology9217]

thank you

[@mwa_911]

Thank you, my friend :)

[@millylovesyou7703]

Good job!!

[@tehreemie]

Thankyouuu!!! Very helpful

[@yusufgunduz6826]

Thanks for the video but let me get this straigth , what do you mean by saying only 80% percent of people who had transplant,survive only 5 years after transplantation?i mean do they live just for 5 years after transplantation?

[@thatguy4087]

I interpret that as 20% do not live for five years

[@sameddonater]

Yüzde 20 si transplant dan sonra en fazla 5 yil yasamis. Diger 80% bes yildan fazla

[@nosh3120]

Nice explanation

[@sumanpreetkaur7819]

Good... Dont know why very less has watched it yet

[@drswetaruparel]

Very helpful !!! 👍

[@pchou]

s/p ERCP w/ stenting would increase complication of future liver transplant though? is stenting encouraged or should we manage with meds until transplant can be done.

[@narandetagenblirtillluft1419]

Woooow very good explanation

[@ZeroToFinals]

Thanks!

[@ankitparjapati9102]

Thanku so much sir😊

[@CM-tu5wo]

wow this is great.

[@ZeroToFinals]

thanks

[@Grumblesxx]

Great video, the podcasts on spotify are really helpful too! Thanks

[@ZeroToFinals]

Glad you like them!

[@김용현-l9b]

Thank you sir^^

[@lardigmer]

Thank you man :)

[@amtalali5529]

effective video

[@rajaraut1762]

Intrahepaic biliary stone and cholangitis, what is the treatment.how many time patient survive without liver transplant.

[@merrywhiterose]

I'm a female & was diagnosed with PSC 2 yrs. ago when I was 60. I had a stricture of the common bile duct, which was found while getting my gallbladder removed, about 20 yrs. ago. At that time most drs. didn't know anything about PSC. Survival depends on how advanced the disease is. If there's a full blockage, it's a trip to the ER for an emergency ERCP with stent placement. I had a full blockage. I ended up in the ICU due to sepsis & dehydration. Sepsis is a common problem with PCP as the inflammation & blockages of the bile ducts can cause bile to reverse back into the liver. Common problems are itching, fever with chills, upper R abdominal pain & FATIGUE. Getting a liver transplant isn't always a cure, because it can reoccur in the new liver. Survival rate without a new liver depends on how advanced the cirrhosis is. It's common to require a liver within 10 yrs. of diagnosis. Most people can't get a liver transplant after the age of 70. In that case they end up dying.

[@panaceaclinic3705]

Wow

[@ifrahakbar5462]

Keep the good work up ! Its amazing specially the animated illustration is way too helpful. Tysm 😊

[@ZeroToFinals]

Thanks Ifrah!

[@medicinemadeeasy3242]

Good

[@ijj0777]

فخامه

[@indethbed2546]

onion skin fibrosis of bile duct seen on histopathological exam

[@kanitidharani2763]

Is it life threatening?PSC

[@abhishekkakativlogs6006]

👍🏻

[@Wishyouendwell100]

Its female :Male 9:1

[@merrywhiterose]

I'm a female & was diagnosed with PSC 2 yrs. ago when I was 60. I had a stricture of the common bile duct, which was found while getting my gallbladder removed, about 20 yrs. ago. At that time most drs. didn't know anything about PSC. Survival depends on how advanced the disease is. If there's a full blockage, it's a trip to the ER for an emergency ERCP with stent placement. I had a full blockage. I ended up in the ICU due to sepsis & dehydration. Sepsis is a common problem with PCP as the inflammation & blockages of the bile ducts can cause bile to reverse back into the liver. Common problems are itching, fever with chills, upper R abdominal pain & FATIGUE. Getting a liver transplant isn't always a cure, because it can reoccur in the new liver. Survival rate without a new liver depends on how advanced the cirrhosis is. It's common to require a liver within 10 yrs. of diagnosis. Most people can't get a liver transplant after the age of 70. In that case they end up dying.

[@hatducky8691]

I was a 12 year old girl when I was diagnosed.. I'm definitely glad I didn't have to go through any major health issues because, well, I was young. I hope you're okay now, I know that stress can certainly hurt

[@jekku4688]

Thank you for this! Sounds like I may be right on track with you--I'm a 60 yr old woman who last year had all sorts of strange symptoms until a CT scan MRI and hida scans showed that I had a stricture in my main bile duct. I had an ERCP last year with no complications. I have felt fantastic ever since, but just recently had a massive gallbladder? attack so had to go in for more MRI scans. Radiologist currently comparing my scans, and my doctor will then determine if I do indeed have PSC. Praying for the best outcome but apparently I'm not alone in my situation.

[@merrywhiterose]

@@jekku4688 Most people with PSC have to get their gallbladder out. There's a facebook page that is helpful: PSC-support (FB primary sclerosing cholangitis & transplant support).

[@mustajabalam3794]

Great explanation

[@aburayhan8112]

Excellent

[@katevoxs7671]

Hi, it's worth stipulating that Urso isn't proven as a successful treatment option for the slowing down of disease progression regarding PSC, but it is believed to be successful in those with PBC as a form of treatment. Also, ERCP can offer balloon dilation techniques as opposed to stenting, for the aid of bile flow.

[@Emb-hs]

Thank you

[@pou2965]

💕💕👏👏👏👏

[@deeb5500]

Wish I would have clicked on this sooner instead of watching 7000 useless videos first. Perfect explanation *clapping hands emoji*