pathology report

[Liver test]

a live biopsy report reads.
Slight portal tract inflammation and slight fatty changes are
present, minimal fibrosis is seen. A moderate amount of
hopatocellular Iron is present. Is this a sign of a liver
disease. Whats the prognosis for this person. He was a
heavy drinker. What about the hepatocellular Iron?

[Kevin Pho, MD]

This is a nonspecific report suggesting slight fatty changes (which  can be caused by alcoholic fatty liver or NASH - non-alcoholic steatohepatitis.  Liver fibrosis are changes that can be caused by chronic liver disease.  

It is impossible to predict a prognosis based on a single liver biopsy result without knowing the patient's presentation and other lab tests.  

Hepatocellular iron can be caused from iron overload diseases like hemochromatosis.  

If this is a consideration, this should be discussed with this person's 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

[Sarah Connors]

If you are the same person with a few earlier posts, the following are my suggestions in general & regarding the biopsy report. Please correct me where I am wrong.
• You do have a past history of heavy alcohol consumption, which presently have quit & your biochemical tests are well within normal range. At the same time you have a general feeling of being unwell.
• My personal advice again would be to take some Vit supplements on a regular basis.
• Regarding trying to understand the biopsy report, if I were in your place won’t waste time trying to know the significance of the typical, juggling technical words used, they just simply point to very early cirrhotic changes, which is the only thing you should know very clearly.
• Abstain from alcohol, regular Vit supplements, would recommend biochemical tests & liver u/s every 3 & 6 monthly as follow-up just to see that things aren’t progressing any further. (Keeping your present results as a baseline.)

[Liver test]

thanks, so these are early signs of possible cirrhosis

[Sarah Connors]

You’re welcome.
• Minimal Fibrosis (Fibrous bands between portal tracts) can be the start of a Cirrhotic process resulting from any insult to the liver, which in your case is past alcohol consumption.
• Steatosis/ fatty liver, occurs in many hepatic conditions of which alcohol is one.
• You can say that it is a very early start/ sign of cirrhotic process or CIRRHOSIS IN INFANCY, which can be arrested at this stage & will not progress any further to a full blown disease, provided the offending agent is removed.
• As regards iron deposition in hepatocytes is concerned that can occur in hemochromatosis (for which there are specific signs, symptoms, tests) as the sensible doc has pointed out.
• But hepatocellular iron deposition, as the biopsy reports says can occur in variety of conditions apart from hemochromatosis, alcohol again is one.
• My final suggestion would be get checked for hemochromatosis for your own peace of mind, get your liver biochemically & sonologically checked at regular intervals keeping a record, keep abstaining from alcohol, relax & leave the rest to God.
• Who knows histopathologically liver might not deteriorate any more, may even revert back with time.

[Liver test]

Thanks,
Is their any treatment to get my iron back to normal. I
belevie this is why I don' feel well. My body feels like
its chemically imbalanced. My appointment with my Dr. is not till
next week. My LFT test are still ok.

[Sarah Connors]

• Why do you have the feeling that iron deposition is making you feel unwell?
• Did you get your serum iron, ferritin, TIBC checked?
• I agree with your feeling that it seems that your body might be chemically imbalanced but to confirm that you need a thorough lab work done.
• Personally would advise you to have your blood sugar tested & have abdominal u/s to see if the pancreas are normal, since alcoholics have a tendency to suffer from Pancreatitis.

Good Luck.

[Liver test]

My Ferritin was almost double. My Dr. said thats no big
deal. That now problerly explains why I have the iron
in my biopsy report. What is ferritin? The amount of iron
in your body.   Thanks.

[Liver test]

Thanks, ferritin was almost double when I got it tested.
Doctor said no big deal. That may now expain why I have
moderate iron in my liver? Hopefully the damage is done and
my liver will stay the same. Also I have had symptoms of
liver disease but most have gone away. Is this normal or
a good or bad sign. My biopsy shows damage, just how much.
Thanks again

[Sarah Connors]

• Serum Ferritin being in the range of double is not that big an issue unless there are symptoms/ signs of iron over load & I agree with your doc that its no big deal, since ferritin levels are increased in Ch Alcoholics too.
• It’s basically a protein that binds iron to itself & most of it is present in the liver & other organs only a small fraction is in circulation.
• You should try to understand in simple words the significance of terms relating to your issue e.g. Hemosiderosis, Hemochromatosis, Cirrhosis, and Pancreatitis. That way you can put more questions to your treating physician.
• Previously you only mentioned about having abnormal liver tests like raised ALT, now you mention that you had signs/symptoms too? What were the signs?
• It’s a very good indication that signs of liver damage have disappeared.
• As regards your biopsy damage is concerned that is minimal, in my personal opinion.
• My advice would be to request your doc to perform the following fresh lab work:

1. Abdominal u/s.
2. Serum amylases, serum ferritin, iron TIBC levels.
3. Liver tests like ALT, GGT, serum albumin levels.
4. Blood sugar fasting & 2 hours after.
5. Serum Lipid profile.

• Was you liver ENLARGED too when your tests were abnormal or now?
• Did you have splenomegaly?
• Did the radiologist mention any thing specific or was the u/s normal/ non revealing?
• Apart from the recurring dermatitis do you suffer from other areas of skin depigmenation?
• Due suffer from arthralgia or arthritis?
• Regarding your query about removing excess iron, the answer is yes but iron chelation therapy is only done when the levels exceed a specific limit.
• To summarize I still believe that all your symptoms are a consequence of past alcohol consumption.
• I would be away for a few days so by the time I’m back you can request your physician to get the above tests carried out, than we can discuss further.

               Good Luck.




            

[Liver test]

Thanks again.
* Test results that I have had. Had a liver spleen results
came back normal. Also right upper quadrant ultrsound. Results
came back as NORMAL. Said the liver was (homogeneous and texture
without focal lesion). Iron test- Iron 72 (range 45-182)
Transferrin 231 (range 180-329) TIBC 325 (range 241-421
Ceruloplasmin 22 ranage (18-36) Ferritin 550 range 22-322.

* skin looks good had numerous doctors visits and the liver
never was mentioned as enlarged.

* symptoms- most have gone away or gotton better.
   Lost 20 pds., tired, growling in the stomache area,
   uranate alot, dry mouth.
* Liver function test still normal. I know I have damage.
  I hope I don't develope cirrhosis or any other possible
  disease that will shut down my liver.

Thanks again for your time. Besides alchol anything else
should I stay away from that may affect my liver. I don't
take any meds.

[Sarah Connors]

• Your previous Iron related tests look pretty normal.
• You won’t develop cirrhosis or liver failure till you take care of it now.
• Can you please get the tests suggested done & post their results.
• Hepatotoxic agents are many like Viruses, Alcohol, and Some Meds. But in your case it was only alcohol, unless you have been prescribed some other meds e.g. Lipid lowering or cardiovascular related etc.

Have a great time & relax.

[Liver test]

ok thanks my appt. is not for 2 weeks.   thanks again

[Liver test]

would you recommend a ERCP test for sclerosing cholangitis
based on the enlarged portal tracts and minimal fibrosis.My
doctor says my biopsy looks good as long as I stop drinking.
I've read on Sclerosing cholangitis and this could be the
start of it????   Thanks

[Sarah Connors]

•Personally speaking, No, I wouldn’t recommend an ERCP at the moment.
•ERCP is a highly informative, invasive technique but it too has its limitations.
•What ever I am suggesting & have previously been, am keeping your history/symptoms in mind.
•Sclerosing Cholangitis can coexist with very early changes of a cirrhotic process, but based on enlarged portal tracts & minimal fibrosis would be a wild guess that you have it.
•My personal approach in any domain of medicine is to start from simple/ non invasive tests & progressing further to invasive, only if required.
•ERCP can very occasionally trigger an attack of acute pancreatitis; the exact figures are not in my mind at the moment as I left hepatobiliary medicine a decade ago.
•I would still recommend that you get the previously mentioned tests carried out along with an oral cholecystogram.  
•Depending on their results only than can one decide that will an ERCP be of any benefit in your particular case.

Relax; abstain from alcohol, healthy diet, exercise, vit supplements & those tests would be my advice till you get the results.

Take care & Good luck.

[Liver test]

Thanks again, I'm going to see another Dr. this week as the
Doctor that performed the Biopsy said I'm all set as my
liver should last for 50 years as he put it. When I ask
him about other test or symptoms I have ,he says no big
deal and is not looking to do other test. He did'nt even
think I needed any follow up. Seems these doctors just want
you in and out as quick as possible. Should I show the
Dr. my biopsy report and then ask him for certain test.
I have been to this Dr. before but he took liver function
test that came back normal twice in 5 months and he thinks
that nothing is wrong with me. When I mention symptoms he
makes nothing of them and says some of them are in my mind.
My goal is to get test that will confirm I have no
liver disease that will cirrosis my liver in the future.
This is hard to do with these doctors as they seem to be
in a world of their own. Nothing for Nothing but they
make good money off my appt. and they should listen to me
a little although most of my info. comes from the internet
which they seem not to like. How should I approach the doctor
this week. He knows I worrried sick about this and also blames
some of my symptoms on stress. thanks I'll get to the bottom
of this eventually but its been 6 months so far. Other than the
ercp is the U/s a good measure of how your bile ducks look.
I also had a liver splean that dye was enjected into my veins.
Thats was a few months ago and game back good. What do that
test for.

[Liver test]

sarah the pathology report states

Slight portal tract inflammation and slight fatty change
are present, minimal fibrosis is seen   ( grade 0 1 /4+)

Like I said Doctor said my liver will last a long time
with these results. Are these normal results for someone
who has had a history of alchol abuse. Or is it possible
it could be from a liver disease, like I'am worried about.
                              Thanks confussed

[Sarah Connors]

•The following are my personal views, advices, recommendations & answers to your queries.
•As far as your liver biopsy is concerned it’s not bad & as your doc has mentioned you need not worry about it. Minimal fibrosis, fatty change etc aren’t life threatening & are reversible provided the hepatotoxic agent is abstained from.
•Like in my previous replies, would advice you to stop spending too much time thinking about Cirrhosis, Sclerosing Cholangitis etc, which you may not be having & spend more time thinking about the symptoms you have.
•I agree that the medical profession has become commercialized like any other but not all docs are that materialistic in their approach.
•Have a rule of thumb, that most patients are right while describing their symptoms & it’s the doc’s job to find a cure/ treatment/ for them using his brains & diagnostic tools.
•Can feel an element of hopelessness, despair, depression, hypochondriasis, after reading your posts. This is pretty normal for any patient to have.
•Each test that I have recommended earlier has a purpose & it’s for your doc to suggest them & NOT YOU.
•Abdominal U/S is a very good technique to see the caliber, nature of your bile ducts. To see if the pancreas & the liver aren’t enlarged. It can rule out sclerosing cholangitis.
•Serum pancreatic amylases to see that you don’t suffer from chronic pancreatitis.
•Blood sugar for Diabetes.
•Urine exam & culture to rule out any infection (UTI), diabetes etc.
•If still that doesn’t satisfy you than I would recommend some kind of a cholecystogram, whether oral or an intravenous. To see the functioning of your gall bladder.
•These tests should help in finding the cause of your symptoms.
•If I were your treating physician wouldn’t have waited a sec to get these tests done.
•Any sensible doc should try to rule out Diabetes, UTI, Hemochromatosis, Dehydration, Supplement deficiency.

   Take care & Good Luck.

[Liver test]

went today to gastro. He did not seem concerned about
anything. He said my biopsy which I showed him the
report showed nothing really wrong. Was not willing to do
any test as he has performed 2 liver function tests
over the last 4 months and they are normal. Also said
scherosing cholangitis is rare and not caused by alchol.
Says I'm fine and thinks its in my head. Should I go to
my primary doctor or make an appointment with another
gastro. Thanks for all you help and I am very worried
about this.