A 38-year-old man with long-standing ulcerative colitis develops progressive pruritus and intermittent jaundice. ALP is 480 IU/L, bilirubin 3.2 mg/dL. Antimitochondrial antibody is negative. Which investigation will establish the diagnosis?
- A Liver biopsy showing interface hepatitis
- B Endoscopic ultrasound with bile duct aspiration
- C MRCP showing multifocal biliary strictures with beaded appearance ✓
- D CT abdomen showing caudate lobe hypertrophy
Correct answer: C. MRCP showing multifocal biliary strictures with beaded appearance
Explanation
Primary sclerosing cholangitis shows multifocal short strictures of intrahepatic and extrahepatic ducts alternating with normal segments, producing the characteristic beaded appearance on MRCP, which is now first-line and avoids ERCP-related pancreatitis risk. Its strong association with inflammatory bowel disease and negative antimitochondrial antibody separate it from PBC. Caudate lobe hypertrophy suggests Budd-Chiari syndrome, not a ductal disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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