Just what does this granulomatous liver disease mean?

[gsue]

I had my gallbladder removed in 1999 which had pus and sludge in it but no stones supposedly but since then I've had several stones removed from my bile ducts through ERCP. This procedure has been done now about 8 times twice in one week. They did a liver biopsy in 2002 and since then I've constantly had bile duct problems and my liver enzymes elevate on and off when my bile ducts become blocked but as for the biopsy I was told at the time not to worry it was just a fatty liver. Now I saw another gastro in the same offices and this doctor has re-evaluated the liver test and said it clearly stated that I had some sort of liver disease and wanted to know why I hadn't been treated for it but I don't understand what it means can you tell me where I can find out more information on this? This is what the liver report says: 1. Focal necrosis, rare, including a focus of non-caseating granulomatous inflammation, etiology undetermined 2. Spotty mild to moderate portal fibrosis with rare periductal fibrosis, etiology undetermined.

There is a spotty mild to moderate portal fibrosis and periductal fibrosis in one portal area. The liver biopsy exhibits mild to moderate hepatocellular unrest, mild to moderate focal steatosis, a rare focus of parenchymal necrosis including a solitary focus of necrosis with a granulomatous response. We would appreciate receiving the results of the evaluation of the intrahepatic and extrahepatic biliary tree ( this is what the pathalogist asked in his report) Why I'm not sure? I don't drink but I did take lipitor and medicines to lower cholestorol until liver started to act up. Now gastro doctor is scaring me saying I have some sort of desease and have to get hepatitis A & B shots . Just how many more ERCP's can I have? This is all beginning to worry me. Should I be thinking of getting second opinions? Is this as serious as she says? She has me taking Urso now and I read on it that is for Primary Bilary Cirrhosis. Is that what this is? She said today that I have granulomous liver scar tisue disease and she needs to do another liver biopsy to see how badly the liver is damaged. She feels it may be getting worse because my stomach hurts in that area all the time and now I'm making stones and they are possibly caused by the liver. However, she is also performing another ERCP because she feels there are more stones they may have missed and she wants to remove them or make sure there aren't any. Any information you could give me would help. I've tried to research this but haven't found much on it. Please tell me where to look and if I should begin to worry about this.  I just can't help but find it odd that this biopsy result was important and no one brought it up until now.  Isn't that unusal?  Thank you

[Kevin Pho, MD]

There can be several causes of granulomatous liver disease.  This can include sarcoidosis, tuberculosis, viral infections (i.e. hepatitis or CMV), toxoplasmosis, temporal arteritis, primary biliary cirrhosis and drug reactions.

The biliary tree was asked to be evaluated because of the possibility of primary biliary cirrhosis.  Further testing can be considered with blood tests looking for antimitochondrial antibodies.

To find the cause of the granulomas, the underlying diseases should be sought - and this can include various tests to look for the possibilities mentioned above.

You can discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com