HBV Carrier .. my latest liver ultrasound report .. your opinion pls ..

Hi All,
I am 39 Male .. here is my yesterday ultrasound and some blood test ..

ultrasound: " ... Liver has normal size with coarse echo pattern, no focal lesion and no dilated IHBR. Normal PV and CBD. Normal hepatic viens .... Conclusion: Chronic Parenchymatous liver disease for laboratory correlation"

several blood test showed:
ALT: 67.5
AST: 41.3
ALT and AST are higher than usual .. iam on entecavir .5mg since 1st of September 2012 .. before using entecavir .. ALT does not exceed 42 and ALT always lower than ALT ..

HDL 57.2
LDL 124.5
CHOL 192.4
ALP 64
CRP Negative
RBC 5.1
WBC 3.6
Platelet 158

I am HBeAg Negative .. PCR result does not show today .. it will show within 10 days .. i expect and hope it will be undetectable .. because i am naive patient .. started with baraclude .5mg ..
in last August .. Fibroscan gave 6.2 kpa .. before using enecavir ..
i use milk thistle, vit d3 5000 iu, curcum, omega 3 .. not everyday .. but almost everyday .. some of them ..

my questions are:
1. "Coarse echo Pattern" what does it mean for liver?

2. Is there any medicine or supplement can remove this coarse echo pattern?

3. why do ALT and AST increase? (i used antibiotic because of influenza for last three weeks)

4. what are PV and CBD?

5. Can Entecavir solve the coarse echo problem?

6. How can I increase WBC and Platelet?

May Allah cure all of us ..

Thank you ..

[calebz]

I wouldn't worry about the ultrasound that much.. they usually write something because they know you are HBV positive.
I don't understand you started antiviral treatment without  baseline HBV DNA ? You need that HBV DNA test to be sure that the antivirals you take are working. Only then you can consult your doctor about the ALT ASP.

[pong58]

Nash

[OrientS]

I think you are right .. because i asked the ultrasound technician during checking is there any fibrosis or fatty liver ..

i know the american protocol and European  protocol whether to start treatment or not  ..
Before treatment starts .. (2010 t0 2012) i did pcr 4 times: the results ranging between 2000 iu up to 5000 iu ..
i personally believe that the right decision for any male more than 35 y with active replication to start baraclude .5 mg ..

[imran4535]

1. Coarse echo pattern varies be degrees, meaning there are different levels. There is a good amount of coarseness in livers with fibrosis, cirhosis, or livers that ar inflamed. But it could also be read in accurately because of fatty liver. Check out this document. http://www.wjgnet.com/1007-9327/9/2484.pdf

2. Reduced inflammation, less hepatitis activity, healthy diet and lifestyle over time will improve liver health.

3. ALT could go up cause you were sick.

My questions to you:
What's your latest fibroscan have you repeated this?
Do you have at least one baseline biopsy?
Ultrasound is heavily dependent on the operator, better to repeat with someone good.

Also please post Liver Ultrasound in Hep C forum, ask for HectorSF and others.

[imran4535]

I would also go back to your doctor and lab and have them review and read the images taken from ultrasound again.

[OrientS]

- My latest fibroscan was on august 2012 .. it was 6.2 kpa ..

- i didn't do any biopsy ..

Thank you Imran ..

[imran4535]

Ok please do the following:

1. Have your ultrasound images re-read for more opinions

2. If Coarse texture is again determined please have them grade it

3. Please compare results of current ultrasound with previous ones

4. Maintain healthy diet, continue ETV and repeat in Ultrasound in 6 months, you are approaching 40 so more frequent ultrasounds are required (every 6 months)

5. Monitor ALT and HBV DNA every three months on first year of ETV

6. Repeat fibroscan when ALT normalizes

7. Highly consider at least one baseline guided biopsy

[OrientS]

Ok please do the following:

1. Have your ultrasound images re-read for more opinions

i will repeat it in a month to compare ..

thank you imran ..

[imran4535]

You're welcome, but, actually my suggestion was to take the images from your recent ultrasound where coarseness was determined and have them checked for a second opinion.

[StephenCastlecrag]

I don't know much about the technical terms used in a US report. You should really ask the radiologist or doctor to explain them to you.

PV stands for portal vein
CBD stands for common bile duct, I think.
Yes, as others explained, ALT can be elevated by medication. It can also vary in a 24 hour cycle.
Generally, if viral load is very very low and ALT normal, fibrosis can be reverted but it takes time.

[OrientS]

Thank you StephenCastlecrag ..