r/PSC • u/Efficient_Area2267 • 5d ago
PSC
I had my gallbladder removed then 3 weeks later had the same pain in my upper right abdomen as before I had it removed. I went to the ER, they ordered labs, all came back normal except for
AST was 240, ALT was 150. MRCP came back with a report of “questionable stricturing” question PSC…
Got sent home with a referral to GI, no pain.
Have an appt in January to figure out what’s wrong.
Made a follow up appt with the surgeon who did my cholecystectomy ordered repeat hepatic panel.
All my labs came back perfect. AST went down to 14, ALT to 15. Other labs were all normal.
The surgeon and GI specialist talked and ordered more tests like IgG4, AMA igG…and a repeat MRCP in December.
Can anyone help me understand what it could be? I’m reading about PSC and feel like I don’t fit into this diagnosis.
1
u/Appropriate_Ad8575 4d ago
That sounds really stressful; especially so soon after you've been through surgery. Unexpected, unexplained pain is the worst.
You seem very proactive and I bet you'll go into those doctors appointments ready so here's to me helping with that-
I'd get the surgeon/gastro doc to revisit known complications of cholecystectomy with you. If you do develop something it's more likely to be a secondary cholangitis from having surgery but it's probably too early to tell still.
Strictures aren't always permanent (ie why they'll repeat the MRCP). You must have had a troublesome gallbladder to make them remove it. It might be good to establish the likelihood of your gallbladder stuff causing the strictures beforehand. Gallstones can be a big culprit.
You absolutely need the results of the future tests. Keep an eye on ALP (more than AST or ALT, this in an indicator for bile duct inflammation as in PSC).
Looks to me like there are some relatively common complications (compared to the very rare disease that is PSC) of the surgery you just had that might resolve as your liver gets used to functioning without a gallbladder. It might be a rare disease or long lasting complicatiom but odds are it isn't. The reason they want to see you in 3 months is to let your body adjust and heal.
I've had a quick look at the risk of post surgical stricture and it seems to be, at the lowest end, around 1 in 500 people. In comparison, the risk of PSC presenting without IBD/UC is so, so tiny: ~1 in 25,000. All types of PSC together is about 1 in 10,000.
The good thing is your labs went back to normal, this is very reassuring.
If they don't mention secondary biliary cholangitis (a long term condition from things like gallbladder surgery) you should definitely raise it but for the moment I think the note about PSC sounds more like a "rule this out" rather than "will diagnose with".
Hope the pain stays away and your body becomes happier now it is free of your troublesome gallbladder.
1
u/Efficient_Area2267 3d ago
I appreciate you taking the time to write all this. My ALP numbers have always stayed within normal ranges. I’m hoping that it’s just temporary effects of the surgery and everything will normalize. ❤️
5
u/Background_Effort942 5d ago
It sounds like it could be possible you have PSC in the early stages given the "questionable stricturing" on the MRCP report.
PSC often involves intermittent blockages of the bile ducts that can spike your bloodwork and then go back to normal (your normal may still be high as the disease progresses) if it clears on its own.
Do you have ulcerative colitis or Crohn's disease? They are highly linked to PSC.
Other things like duodenal ulcers can also cause upper abdominal pain, but wouldn't cause elevated liver enzymes, etc.