Do I have PSC ? (Generalized itching)

[eman]

Greetings,

I've posted here before. I had my colon removed Feb 2004. I had a breif spike in my liver enzymes about 6 weeks after my colon was removed, and the enzymes went back to normal a few days after my loop ileostomy was connected to my j-pouch. My doctor theorizes that the elevated enzymes were a combination of iron anemia, dehydration and physical stress. I also had MRCP done at this time, which came out negative for any bilary obstruction or thinning of the ducts.

My current problem is generalized itching. My first outbreak was during the period where my liver enzymes spiked. It eventually subsided. About 7 months later, I had another terrible generalized itching attack. It lasted for a few weeks. My blood/liver stats were completely normal during this attack. I even had an MRI that showed nothing.

6 weeks ago, I had another terrible attack of generalized itching. It is still going strong. My current stats are:
Bilirubin 0.6, Alk Phos 52, AST 27, ALT 24. Everything else is also in range. My doctor cannot justify more MRCP/ERCP/Liver biopsy with stats this good. I've done massive amounts of research on PSC, and cannot find out whether it's possible to have generalized itching with completely normal LFT ranges. Also, I've seen Dermatoligists, and Allergists. There is no problem with my skin. This has got to be systematic. I realize that general itching can be a precurser to cancers and other diseases. I've been tested for everything that it could possibly be at this point. I want to know if this correlates with PSC. Here are my questions, and please feel free to elaborate on anything I've talked about.

Is generalized itching a sign that I may have PSC? (without any evidence in blood work, recent MRI, or MRCP)

If not, could it be something related to total colectomy? (I've only had these 3 itching episodes after colectomy).

Would you reccomend my liver be tested again?

If not, would you reccomend any other type of test?

Have you ever seen anything like this before? If so, please elaborate.

thanks,

eman

[Kevin Pho, MD]

To answer your questions:
1) It is possible for generalized itching to be a sign of PSC.  There is no way of knowing for sure without appropriate testing.

2) Although possible, I am not aware of generalized itching being a complication of a colectomy.

3) I would suggest testing for PSC.  This can include an ERCP/MRCP, ultrasound or a liver biopsy.

4) I have seen cases of generalized itching before.  There are many causes for this - and by going to dermatologists, allergists etc., most of the more common ones would have been considered.  

You can consider an MRCP as an initial test to evaluate for PSC - although the yield may be low in the setting of normal liver enzymes.

This option can be discussed with your personal physician.

Followup with your personal physician is essential.

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, M.D.
http://www.straightfromthedoc.com

[eman]

I forgot to mention, the only drug I use is loperimide. I take 16 mg daily.


eman