Is PSC excludable in this circumstance?

30 year old male with Crohn's disease and six months of mild elevations of ALT and AST.  AP has only been elevated slightly once (at least in these past months).  I also had high fever episode a few years ago with moderate elevations of these enzymes plus AP elevation, and a CT showed hepatosplenameglia.  MRI six months ago showed normal liver.  They are now doing an MRCP and a liver biospy, presumably in part to exclude Primary Schlerosing Cholangitis.  No juandice symptoms, but I do have new itchiness, dry skin issues (leg rashes from itching) but I think that is allergies to something.  

Question - I understand that PSC is a bilary tract disease, and my liver enzyme pattern, at least currently, does not include elevations of those enzymes associated with bilary disease (AP, biliburin, GGT...).  Instead I just have raised ALT and AST.  Does this pattern exclude PSC? Or can PSC exist without causing raised bilary-type enzymes?  
And, is the MRCP and biopsy too aggressive?

Thanks.

[Kevin Pho, MD]

I agree with the tests to exclude PSC, and the MRCP and biopsy would be part of a pretty conclusive evaluation.

The liver biopsy will also evaluate for other liver diseases that can raise the liver enzymes.  

If these tests are inconclusive, an ECRP - which is a more direct visualization of the biliary tree - can be discussed with your gastroenterologist.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[SF2223]

Thanks for your comments. MRCP came back normal except "punctate T2 hyperintense focus in the anterior aspect of the liver as well as in the upper pole of the right kidney, too small to characterize further at cross-sectional imaging, and likely to represent simply cysts."

Do you think that is cause for follow-up?