Recognizing primary biliary cirrhosis and primary sclerosing cholangitis.

Nonsuppurative cholangiopathies such as primary biliary cirrhosis and primary sclerosing cholangitis are chronic cholestatic liver diseases that result from inflammation of the biliary system. Recent advances in management options for patients with primary biliary cirrhosis and primary sclerosing cholangitis have facilitated treatment by family physicians. Patients with significant laboratory abnormalities on liver tests for cholestasis should be evaluated for possible primary biliary cirrhosis or primary sclerosing cholangitis. Investigation with liver biopsy and endoscopic retrograde cholangiopancreatography should be considered if abnormal biochemical findings remain unexplained after a careful history and physical examination are performed, a thorough medication history is obtained and abdominal ultrasonography is conducted to search for biliary obstruction.