Men are affected more often than women. The disease was initially described in the mid-1800s, but was not fully characterized until the 1970s with the advent of improved medical-imaging techniques such as endoscopic retrograde cholangiopancreatography. Signs and symptoms
Nearly half of people with PSC do not have symptoms, and are often incidentally discovered to have PSC due to abnormal liver function tests; however, a substantial proportion have debilitating signs and symptoms of the disease. Signs and symptoms of PSC may include severe itching and nonspecific fatigue. Yellowing of the skin and white portion of the eyes may also be seen. Enlargement of the liver and spleen are seen in roughly 40% of affected individuals. Abdominal pain affects about 20% of people with PSC.Multiple episodes of life-threatening acute cholangitis (infection within the bile ducts) can be seen due to impaired drainage of the bile ducts, which increases the risk of infection. Dark urine due to excess conjugated bilirubin, which is water-soluble and excreted by the kidneys (i.e. choluria)
Malabsorption, especially of fat, and steatorrhea (fatty stool), due to an inadequate amount of bile reaching the small intestine, leading to decreased levels of the fat-soluble vitamins, A, D, E, and K.
Portal hypertension, a complication of cirrhosis, which can manifest with esophageal and parastomal varices as well as hepatic encephalopathy (mental status alteration/disturbance caused by liver dysfunction and shunting of blood away from the scarred liver; such that ammonia detoxification is reduced with concomitant encephalopathy) or ascites.
Criminalization of attempted suicide
Historically in the Christian church, people who attempted suicide were excommunicated because of the religiously polarizing nature of the topic. While previously criminally punishable, attempted suicide no longer is in most Western countries. It remains a criminal offense in most Islamic countries. In the late 19th century in Great Britain, attempted suicide was deemed to be equivalent to attempted murder and could be punished by hanging. In the United States, suicide is not illegal and almost no country in Europe currently considers attempted suicide to be a crime.In India, attempted suicide was decriminalized by the Mental Healthcare Act, 2017, while Singapore removed attempted suicide from their criminal code in 2020; previously it had been punishable by up to one-year in prison.Many other countries still prosecute suicide attempts. As of 2012, attempted suicide is a criminal offense in Uganda, and as of 2013, it is criminalized in Ghana.Despite having its own laws, Maryland still reserves the right to prosecute people under the English Common laws that were in place when America declared independence in 1776. These laws were used to convict a man for attempted suicide in 2018, resulting in a three-year suspended sentence and two years of supervised probation. See also
International Survivors of Suicide Loss Day
Suicidal ideation
World Suicide Prevention Day


== References ==