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Primary sclerosing cholangitis (PSC) is a rare, long-term liver disease caused by ongoing inflammation of the bile ducts—the tubes that carry bile from the liver to the intestines. Over time, this inflammation leads to scarring and narrowing of the bile ducts, which blocks bile flow, damages the liver, and gradually reduces the liver’s ability to filter blood and aid digestion. Key facts about PSC Rarity: Affects up to 1 in 10,000 people Association: Strongly linked with inflammatory bowel disease (IBD), especially ulcerative colitis Cause: Believed to be immune-mediated, meaning the immune system mistakenly attacks the bile ducts Progression: Chronic and slowly progressive Risks and complications People with PSC have a higher risk of: Liver failure Cholangiocarcinoma (bile duct cancer) Gallbladder cancer Colon cancer (especially if IBD is present) Management and treatment There is currently no cure for PSC except liver transplantation in advanced disease. Care focuses on: Regular monitoring of liver function and bile ducts Managing symptoms such as itching and fatigue Treating complications Endoscopic procedures to temporarily open narrowed bile ducts when needed Conditions that may resemble PSC Several bile duct disorders can look similar but are distinct: Secondary sclerosing cholangitis: Caused by another problem (infection, gallstones, surgery, injury). May improve if the underlying cause is treated. Pediatric PSC: Occurs in children or teens and may overlap with autoimmune hepatitis. Ascending cholangitis: A sudden, severe bacterial infection of the bile ducts, usually due to blockage by gallstones. This is a medical emergency. Primary biliary cholangitis (PBC): An autoimmune disease affecting smaller bile ducts inside the liver, mostly in women, and often responds to medication.

Toxic hepatitis is inflammation of the liver caused by exposure to harmful substances, such as alcohol, medications, chemicals, or herbal/nutritional supplements. It may develop within hours or days after exposure, or after months of repeated contact. Symptoms often improve once the toxin is stopped, but severe cases can lead to cirrhosis or life-threatening liver failure. Symptoms Mild cases may have no symptoms and are found on blood tests. When present, symptoms include: Jaundice (yellowing of skin/eyes) Itching Pain in the upper right abdomen Fatigue Loss of appetite Nausea and vomiting Fever or rash Weight loss Dark (tea-colored) urine Emergency: Suspected acetaminophen (paracetamol) overdose requires immediate medical care—do not wait for symptoms. Causes Alcohol (long-term heavy use) Over-the-counter pain relievers (acetaminophen, aspirin, ibuprofen, naproxen), especially in high doses or with alcohol Prescription drugs (e.g., statins, certain antibiotics, antivirals, steroids) Herbs & supplements (e.g., aloe vera, black cohosh, kava, ephedra) Industrial chemicals (e.g., carbon tetrachloride, vinyl chloride, paraquat) The liver breaks down toxins, but byproducts can damage liver cells—repeated exposure increases harm. Risk Factors Existing liver disease or viral hepatitis Older age Female sex (slower toxin metabolism for some substances) Certain genetic enzyme differences Complications Cirrhosis (permanent scarring) Acute or chronic liver failure Liver transplant may be required in severe cases Prevention Use medicines only as directed; avoid unnecessary use Never mix alcohol with acetaminophen; ask about other drugs Be cautious with herbs/supplements—discuss risks with a professional Use protective measures when handling chemicals Keep medicines and chemicals out of children’s reach Bottom line: Toxic hepatitis is often preventable. Early recognition and stopping the offending substance can protect the liver and prevent serious complications.