How is dx of PSC?

Clinical (fatigue, pruritis, jaundice, weight loss, fever, hepatomegaly, splenomegaly, hyperpigmentation, IBD (ulcerative colitis and crohns less likely)) Labs (elevated ALP 3-5 x normal, mild ALT/AST elevation, serum Bi fluctuates (complications like cholangiocarcinoma, strictures) non-organ specific autoantibodies) Radio (ERCP (first choice) if unsuccessful percutaneous transhepatic cholangiography), MRCP) We see diffuse multifocal annular strictures extra and intrahepatic bile ducts, short bandlike strictures, diverticulum like out pouchings, pancreatic duct involvement causes chronic pancreatitis) Histology (4 stages: periductal fibrosis, bile duct proliferation, ductal obliteration and ductopenia)