Pathological Changes in Various Forms of Liver Disease

Biliary Tract Diseases: Primary Biliary Cholangitis vs Primary Sclerosing Cholangitis

The liver plays a vital role in maintaining metabolic homeostasis and detoxification, but various liver diseases can significantly impact its function. Among biliary tract diseases, Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC) are two major conditions affecting the bile ducts.

Primary Biliary Cholangitis (PBC)

PBC is an autoimmune disorder characterized by progressive destruction of the intrahepatic bile ducts, leading to cholestasis and fibrosis. The pathological features of PBC include:

• Florid duct lesions: Chronic inflammation around small bile ducts.
• Ductopenia: Loss of intrahepatic bile ducts.
• Cirrhosis: Advanced fibrosis resulting in hepatic failure.

Primary Sclerosing Cholangitis (PSC)

PSC is a chronic inflammatory condition marked by progressive fibrosis affecting both intrahepatic and extrahepatic bile ducts. Common pathological characteristics include:

• Periductal fibrosis: ‘Onion-skin’ fibrosis around bile ducts.
• Biliary strictures: Narrowing and obstruction leading to cholestasis.
• Risk of cholangiocarcinoma: Malignant transformation in long-standing cases.

Diagnosis and Management

Diagnostic approaches include serologic markers, imaging techniques such as MRCP, and histopathological examination. Treatment primarily involves symptom management, with liver transplantation being the definitive option for end-stage disease.

Conclusion

PBC and PSC, though both impacting bile ducts, differ significantly in etiology, pathology, and progression. Early diagnosis and appropriate management are crucial to improving patient outcomes.