Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive inflammation, fibrosis, and stricturing of the intrahepatic and extrahepatic bile ducts, leading to bile duct obliteration, secondary biliary cirrhosis, and liver failure. Unlike PBC, PSC lacks a specific autoantibody, though perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) are present in 80% of cases. PSC has a strong association with inflammatory bowel disease (70-80% of PSC patients have ulcerative colitis), and the two diseases may share immune-mediated pathogenic mechanisms involving gut-liver axis immune trafficking. Bile duct strictures cause cholestasis and recurrent episodes of acute bacterial cholangitis (fever, jaundice, right upper quadrant pain -- Charcot triad), which can progress to sepsis. PSC carries a significantly increased risk of cholangiocarcinoma (10-15% lifetime risk), making surveillance essential. The nurse monitors liver function tests (alkaline phosphatase, bilirubin), assesses for signs of acute cholangitis (fever, jaundice, abdominal pain), monitors for complications of cholestasis (pruritus, fat-soluble vitamin deficiency, osteoporosis), assists with ERCP for dominant stricture dilation, monitors for cholangiocarcinoma (CA 19-9, MRI surveillance), manages complications of portal hypertension, and coordinates liver transplant evaluation for progressive disease.