Cirrhosis and Biopsy

Have any of you been told flat out you have cirrhosis without a biopsy?  My teams of doctors are all insisting I have it, but a biopsy has not been performed.  Any thoughts?

[BS1961]

My doctors said they were pretty sure I had it. They based it on elevated amonia (ammonia) levels and looking at other blood tests plus an enlarged spleen. Also I was a 3/4 on my biopsy 2 1/2 years ago. I had a biopsy 2 months ago that showed cirrhosis.

[rearfang]

I know that if your liver is in rough shape they can tell by how it feels, etc... but not knowing any other details (how the drs. arrived at this conclusion, what your history is), I wouldn't want to make a guess. There are varying degrees of cirhossis. Even if it is in bad shape, you still have options and a chance to heal some of the damage.

[couchpotato]

My husband never had a biopsy. He was dx with hep c about 4 years and nobody was particularily concerned. (we knew nothing). Anyway, with further blood work a year or so later he was found to have an enlarged spleen, high ALT and AST, and low platelets. His GI doc suspected cirrhosis and sent him to Transplant physicians and just with a quick physical and a look at lab work, they decided he needed to be monitored for future transplant. No biopsy would be performed because his low platelet count would make it risky. Although a biopsy will give you an absolute picture as to your liver's health, I don't believe it is the answer for everybody. How are your platelet numbers? Could this be the reason why you are not having the bx?

Mattie

[ellissg]

No biopsy due to blood thinners. Had a Fibrosure that caame back Stage 4 Cirrhosis. Dr. ordered an MRI. Results did not back up the Fibrosure results. My Liver and Spleen sizes are normal. No pancreatic or common bile duct dilatation. My Albumin and Protein levels are at the high end, indicating no fibrosis. Liver measures 15cm and spleen 11cm.

There is no evidence of Ascites. No Gallbladder distension. No pancreatic enlargement or mass. Also,I have none of the symptoms of Cirrhosis, even those associated with early stage.

I feel GREAT! But my last Viral Load was 2,000,000. I'm 66 and the Doctor wants to wait before treating again.

Steve

[Naterpotater]

They have never checked my ammonia levels that i know of. My platelet count is low, although the hemotologist had no worries about me getting a biopsy done, my doctor still decided not to.  I did have Mono, could that effect my spleen long term as well.  I ask these questions, but never get a clear answer from the doctor. Also, they are not only monitering me for transplant.  I am on the list...Oh well, one day at a time.

[Califia]

No doubt...but we must be talking about the _degree_ of fibrosis then, because I'm definitely at stage 2.5 (or was) and have always had great protein and albumin levels, like fifteen years' worth.

[ellissg]

Thanks Frank!

revenire____My spleen is not enlarged. Ascites is what happens in a cirrotic liver. It means that blood is backing up into the speen, instead of being processed by the liver. Of course if my spleen had been enlarged, I would take the Fibrosure test at face value. But that test isn't FDA approved, and has a poor record of accuracy due to many factors.

[Califia]

I'm unclear about one thing.   Since when do high levels of protein and albumin indicate lack of fibrosis?  I have it and my P and A levels have always been high, which simply shows good liver function in spite of .    You trust your doc?

[ellissg]

That information is everywhere, but the latest that I got was from the Colorado Center for Digestive Disorders..."When the liver has been chronically damamged, Serum Albumin will be low.
Low total protein will also suggest liver disorder. It's also on the Liver Foundation site where they relate those levels directly to fibrosis.

[scruffy]

Man that fibrosure result must have scared the heck out of you-I'm glad other tests did'nt back it up. REALLY glad you're feeling great Steve. Be happy. frank

[LvdByGod!]

i think youre talking about portal hypertension and not aeseties...aeseties is where the albumin is too low and the veins leak fluids and they build up in the abdomin (abdomen)...

portal hypertension is where the blood backs up into the spleen and causes enlarged spleen...

rev, i have was told i had a moderately enlarged spleen but then was said to have stage 3 grade 3 bridging fibrosis 2 years ago on biopsy....and now i am really curious whether i have increased fibrosis, decreased or about the same being on tx now for a year and a half...????

really wish i knew with my recent "aeseties" scare...i wonder if fibrosure would be good at this point?...but i'm still on tx...would it be accurate?

[Califia]

Those were great fish!   Bet your cats are still lurking around the monitor.  

I noticed there was more reporting on Fibrosure at the recent EASL, and medical buzz is starting to get  a little more favorable about non-invasive alternatives to bx.  I'd go straight to your doctor on this one.

[LvdByGod!]

my computer doesn't even let me do those dashes and dots but i just pasted it from another persons post on a different forum...what a cheater i am!!! it's what you call non original art or plagerism...artistically, that is...

oh the kitties say meow to you too calif!!! :O)