<prompt> A 35 year old male presenting with recurrent episodes of abdominal pain, jaundice and fatigue underwent MRCP shown below. What is the most likely diagnosis?Primary Sclerosing CholangitisPrimary Biliary CirrhosisOriental CholangitisCarolis Disease  <response>: The given MRCP image which shows multiple intrahepatic and extrahepatic segments of stricturing, along with given clinical features are suggestive of Primary sclerosing cholangitis. Primary Sclerosing Cholangitis PSC PSC is a chronic cholestatic syndrome that is characterized by diffuse inflammation and fibrosis involving the entire biliary tree, resulting in chronic cholestasis. It leads to obliteration of both the intra- and extrahepatic biliary tree, leading to biliary cirrhosis, poal hypeension, and liver failure. Patient usually presents with fatigue , pruritis , and upper abdominal pain. Jaundice and icterus may also be present 70 cases are associated with IBD. On MRCP, it shows shows multiple intrahepatic and extrahepatic segments of stricturing , known as Prune tree appearance. Figure1: MRCP image showing Primary Sclerosing Cholangitis Figure 2: Actual picture of tree with pruning 