This patient presents with a number of classic extraintestinal manifestations of ulcerative colitis. Progressive fatigue,
pruritus, and icteric sclera are clinical manifestations of primary sclerosing cholangitis, an irreversible condition characterized by inflammation, obliterative fibrosis, and segmental constriction of intrahepatic and extrahepatic bile ducts seen in patients with ulcerative colitis. On endoscopic retrograde cholangiopancreatography (a radiographic visualization of the pancreatic duct and biliary tree), these bile duct changes are visualized as alternating strictures and dilations, or “beading.”
Cholelithiasis, also known as gallstones, is not associated with ulcerative colitis. Endoscopic retrograde cholangiopancreatography may be used to visualize a ductal stone but is not a modality of choice for gallstone detection.
Pancreatic carcinoma is not associated with ulcerative colitis. On endoscopic retrograde cholangiopancreatography, it is characterized by a double-duct sign that results from tumor obstruction of both the common bile duct and the main pancreatic duct, not beading.
Primary biliary cirrhosis is a nonsuppurative, granulomatous destruction of medium-sized intrahepatic bile ducts. It is not associated with ulcerative colitis. Endoscopic retrograde cholangiopancreatography findings in this condition are nonspecific.
Primary hemochromatosis is a familial defect in control of iron absorption with massive accumulation of hemosiderin in hepatic and pancreatic parenchymal cells. This condition is not associated with ulcerative colitis and has no specific endoscopic retrograde cholangiopancreatography findings