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Is MRCP recommended after diagnosed with Stage 1 PSC?

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Gastroenterologist
Practicing since : 1996
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I am from Jacksonville, FL when I had asked you about my 23-year old daughter having to go through liver biopsy. Sad news - she has been diagnosed with Stage 1 PSC - BUT the doctor now wants to do an MRCP.....why would she not have recommended that in the first place and done the MRCP first and then the biopsy. she said that now she has to rule out large duct....we kept asking her about the MRCP first. it is possible that that the doctor is right - but I wish the sequence could have been the MRCP first - that would have told us whether the large ducts have been affected. The doctor says it is a genetic disease - is that right? hope you are doing well. Look forward to hearing back from you. Thank you so much.
Posted Sat, 21 Dec 2013 in Liver and Gall Bladder
 
 
Answered by Dr. Ratnakar Kini 14 hours later
Brief Answer: Detailed answer given below Detailed Answer: Hi, That is really a sad news. Regarding the MRCP, I was discussing with you in the other thread, that it is always better to start with MRCP and then proceed to biopsy if needed. Coming to your daughter's case - yes MRCP has to be done to know if large ducts are involved. As said earlier, small duct PSC is diagnosed only if the cholangiogram is normal. We should know whether it is a small duct PSC or the classic PSC involving the large ducts. This is because small duct PSC has got a better prognosis. The exact cause of PSC is not clearly known. Genetics do play a role but not entirely responsible for the development of PSC. Immunologic factors, infections, toxins and vascular factors also play a role. If I am right your daughter has UC. So immunologic factor is one of the key factors in her case if PSC is confirmed. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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Follow-up: Is MRCP recommended after diagnosed with Stage 1 PSC? 11 minutes later
We have moved all her records to Mayo Clinic here, not sure if you have heard of Mayo Clinic, it has very high reputation. The Hepatologist we will be seeing has over 80 patients with PSC, at least someone with experience with this rare disease. Does the fact that the doctor said it is Stage 1 mean that more than likely the large ducts are involved? Or can small duct PSC also be staged? Thanks so much.
 
 
Answered by Dr. Ratnakar Kini 11 minutes later
Brief Answer: Detailed answer given below Detailed Answer: Hi, Histologic staging of PSC gives information on the extent of damage of liver due to the disease process and not which duct ( small or both large & small) are involved. Btw all the doctors know about Mayo Clinic and we in fact have a Mayo Clinic Model based prognostic formula for PSC. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
Follow-up: Is MRCP recommended after diagnosed with Stage 1 PSC? 10 minutes later
I thought you would know about Mayo Clinic. We are thankful we live in the same city as where Mayo Clinic is located.....small mercies. It is excellent that this XXXXXXX is being used by your practice also. So, at some levels I am a little upset with the first GI / Hep who despite us repeatedly asking for the MRCP, did not start with that first. Is there in anyway we may have known this if we had done the test for alkaline phosphatase perhaps a few years back....just an academic question? Thanks so much.
 
 
Answered by Dr. Ratnakar Kini 24 hours later
Brief Answer: Detailed answer given below Detailed Answer: Hi, PSC progresses through four phases - asymptomatic, biochemical, symptomactic and cirrhotic. During the asymptomatic phase, the alkaline phosphatase would be normal only. So it depends on during which phase you do the tests. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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Follow-up: Is MRCP recommended after diagnosed with Stage 1 PSC? 5 minutes later
Dr. Kini - Thank you. In my response above, I meant to say MODEL - not sure what the auto correct in my iPad did and I did not notice it either - my apologies. There are no symptoms at this time - not that I can discern anything - no pain or jaundice or itching etc - but the alkaline phosphatase level as of Oct 2013 was 4 times elevated. So - would this stage be called the biochemical - even though no symptoms per se? Do you know anything about the value of taking turmeric and / or milk thistle? Probiotics?
 
 
Answered by Dr. Ratnakar Kini 13 minutes later
Brief Answer: Detailed answer given below. Detailed Answer: Hi, Yes, she is in the biochemical phase now. These do not provide a cure from PSC but may be helpful in protecting the liver and slowing down the progression of the disease. No harm in trying these supportive therapies along with the conventional one. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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Follow-up: Is MRCP recommended after diagnosed with Stage 1 PSC? 28 minutes later
Dr. Kini - Thanks again. Any side effects from taking turmeric or milk thistle since she also has UC? Fresh turmeric or powder mixed with water - only if you have any suggestions? any other natural products? look forward to your feedback.
 
 
Answered by Dr. Ratnakar Kini 21 hours later
Brief Answer: Detailed answer given below Detailed Answer: Hi, There are no side effects from taking either turmeric or milk thistle even if someone has UC. It is the curcumin present in turmeric that is responsible for its beneficial effect. So you can take turmeric in whatever form you like. I am not aware of any other natural product that is beneficial for individuals with PSC. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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Follow-up: Is MRCP recommended after diagnosed with Stage 1 PSC? 1 hour later
Greetings Dr. Kini, Thanks again for your thoughtful responses - appreciate it. We are still hoping and being meditative - hoping that the MRCP would say that it is the small duct PSC, and not the classic PSC. I read in a few places about the laxative effect of milk thistle - that is why I wondered about it. Good to know there are no detrimental side effects. Any detrimental effects of taking lemon water in the mornings? In your practice, do you have any cases of young women in their 20s or younger who have PSC? Look forward to your feedback.
 
 
Answered by Dr. Ratnakar Kini 19 minutes later
Brief Answer: Detailed answer given below Detailed Answer: Hi, Not all patients develop loose stools after taking milk thistle. Many of my patients have taken milk thistle for other liver related disorders and no one came back to me complaining of this particular side effect. But always inform the treating physician before starting anything. I advise my patients to avoid lemon only if they have acidity related issues. I usually see only males with PSC. Even today I happened to see a patient with PSC- but a male. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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Follow-up: Is MRCP recommended after diagnosed with Stage 1 PSC? 26 minutes later
Thank you - thank you - thank you - has been a tremendous help to get your feedback every single time. My daughter is all set to apply to medical schools here - and so she is still carrying on with that goal - getting her recommendations / personal statements / applications etc. She is so calm and cheerful which is a blessing at this time. We have an appointment with a hepatologist at Mayo Clinic on Tues - Dec. 3. I am nervous that the doctor is going to prescribe Ursodiol since she has been cited in medical articles - just my own nervousness based on reading from authentic web sources. I have read about Vancomycin which has been used by Dr. XXXXXXX Cox at Stanford - seems to be semi successful. I am sure you must have read about it. Do you have any pediatric - up to 18 years of age - kids with PSC? Thank you.
 
 
Answered by Dr. Ratnakar Kini 48 hours later
Brief Answer: I see mainly adult patients. Detailed Answer: Hi, I see mainly adult patients. The youngest I have seen is a 22 year old guy. Yes, I have read about using vancomycin for PSC - in research papers and in case studies only. It has not found a mention in textbooks yet. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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