Aa
Need your opinion about liver biopsy please
I'm 53, asian male; got real sick in 1986 from Hepb (no idea how I got it) ; then recover but remain a carrier since then. I'm e antigen negative & e antibody positive.
I have been wondering whether I need a liver biopsy over the past few years, and my family practice doctor (I'm not seeing any liver specialist) told me I don't need one the reason being as follows:
1. white blood count is within normal range
2. plate count is within normal range
3. ALT range from 22 to 34 over the past four years
4. liver ultra sound normal
5. VL range from low of 32 (9/09) to high of 3610 (12/07) iu/ml
last count was 1250 iu/ml on 7/10, alt was 25.
and there is no fibroscan here.
Also is it normal to have some minor liver pain once in a while? Thank you for your time reading thru my post.
I have been wondering whether I need a liver biopsy over the past few years, and my family practice doctor (I'm not seeing any liver specialist) told me I don't need one the reason being as follows:
1. white blood count is within normal range
2. plate count is within normal range
3. ALT range from 22 to 34 over the past four years
4. liver ultra sound normal
5. VL range from low of 32 (9/09) to high of 3610 (12/07) iu/ml
last count was 1250 iu/ml on 7/10, alt was 25.
and there is no fibroscan here.
Also is it normal to have some minor liver pain once in a while? Thank you for your time reading thru my post.
I asked my doctor the same questions. He said he needs to know the whole picture of disease. For example, if your condition is too advanced, he may need some other treatments. He also needs to gauge the effectiveness of the treatment down the road, so a reference status is so important. He also will manage the monitoring plan. In my case, my biopsy is G0-1F0. My doctor doesn't need to worry about the cirrhosis, if the virus is suppressed as plan. He will not be very aggressive in that aspect down the road as long as my hbv dna is UND and ALT normal. Otherwise he will need to order a lot of different tests to gauge the status of the liver during treatment, which is often very difficult since biopsy can not be performed regularly and fibroscan is not available in US. If biopsy is F3, there will be completely different disease management than that of F0-F2, because cirrhosis risk is very high.
Why bother to find out?
well, i totally agree with you.
I think right now I'll just have to decide whether to get a liver biopsy to determine to take drug or just go with your way of managing the HBV.
well, i totally agree with you.
I think right now I'll just have to decide whether to get a liver biopsy to determine to take drug or just go with your way of managing the HBV.
The point is: by 2007 guideline, you are 53 with HBV, whether your gentotype is B or C, whether you have mutated to precore bcp or not, a Western doctor will ask you to get on antivirals. Why bother to find out?
Thank you so much for your lengthy response. Greatly appreciated!
Q: you are asian too so your gentotype is B or C, did you chek it?
A: No
Q:at your age hbv has mutated to precore bcp both are reliable markers of future liver cancer development, did you check for these?
A: No.
You are right. I'm going to ask my doc next week when I see him about my blood test & about the biospy.
Thank you !!
Q: you are asian too so your gentotype is B or C, did you chek it?
A: No
Q:at your age hbv has mutated to precore bcp both are reliable markers of future liver cancer development, did you check for these?
A: No.
You are right. I'm going to ask my doc next week when I see him about my blood test & about the biospy.
Thank you !!
i ve made 2 biopsies in my life and if doctors is good there nothing to be worried about, they used to do it with ultrasound 10-20years ago so they see exactly where they go, it is not an injection but very similar
fibroscan are much better and sensitive since you can monitor monthly during therapy but if they are not available only biopsy can tell
keep in mind that all blood tests are normal both in cirrhosis and liver cancer, when you get abnormal blood tests about cirrhosis it is so advanced that there is no coming back even with therapies
thanks for your advice; I just have my blood drawn this week and I will know the result next week; and I think i'm going to see a liver specialist to get a second opinion about my situation; I read about a study in Korea; they found out many hepb e antigen negative carriers with low viral load of less than 2,000 IU/ML got liver damage already.
No i am not on any drugs, but had my gallblder removed due to stones and sinse then feel the pain. Liver biopsy is very safe and simple procedure it takes 2 minutes after they numm you. But make sure liver specialist is doing it. I wuld strongly recament it is the only way to know your liver situation,dont look on you tube is not reel. I am glad I had my done .
no, I don't feel pain in right shoulder.
Are you on any cholestrol lowering drug like crestor, lipitor, lopid etc;? I used to take lopid for over ten years and I always had abdomen pain & discomfort and left leg pain (once got up in the morning); doc had no idea why? and two years ago, after I read over 20 books about nutrition and those cholestrol drug side effect; I stop taking the drug and stop eating JUNK (processed food etc)! ; since then all my leg pain and abdomen pain all disappear;
yeah, I still debating about the liver biopsy; and I'm kind of scared about the procedure (from you tube).
Are you on any cholestrol lowering drug like crestor, lipitor, lopid etc;? I used to take lopid for over ten years and I always had abdomen pain & discomfort and left leg pain (once got up in the morning); doc had no idea why? and two years ago, after I read over 20 books about nutrition and those cholestrol drug side effect; I stop taking the drug and stop eating JUNK (processed food etc)! ; since then all my leg pain and abdomen pain all disappear;
yeah, I still debating about the liver biopsy; and I'm kind of scared about the procedure (from you tube).
I think you shuld see liver specialist and have a byopsy done, not all doctors know a lot about hep. b
I feel also pain my comes in diferent spots every time comes and goes for 3 years now and all my tests mormal even byopsy was normal now I feel it in the beck to the reight it is woreeing me . And do you feel pain in reight shulder somethimes?
I feel the pain is on the left front lobe (in the middle of my chest) of the liver; really hard to describe the pain though: not sharp but not dull either. I had this pain last November for about 3 weeks then went away but came back recently.
What does your liver pain feel like ?and do you feel it in the beck on the reight side ?
I think I'll ask to have a MRI done to check it out.
BTW, here is the link for a presentation regards to eantigen negative HBV viral load fluation ; very informative.
http://www.chronicliverdisease.org/webcasts/topics/Mgmt_of_HBV_HBeAg_Negaitive_Patients/tsai/webcast/
check it out.
on 9/09, my vl was down to 32 iu/ml but it went back up afterward; so one low reading does not mean anything.
BTW, here is the link for a presentation regards to eantigen negative HBV viral load fluation ; very informative.
http://www.chronicliverdisease.org/webcasts/topics/Mgmt_of_HBV_HBeAg_Negaitive_Patients/tsai/webcast/
check it out.
on 9/09, my vl was down to 32 iu/ml but it went back up afterward; so one low reading does not mean anything.
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at 53yo usually liver cancer or cirrhosis can show up at the highest percenatges more than in other periods of life, if hbvdna is not fully suppressed below 300copies/ml (about 50iu/ml) both liver cancer and cirrhosis can be present (alt is not useful and can be normal with cirrhosis/liver cancer development)
you are asian too so your gentotype is B or C, did you chek it?both have much more higher risk for cirrhosis/liver cancer than caucasians genotypes A, D
at your age hbv has mutated to precore bcp both are reliable markers of future liver cancer development, did you check for these?
your anser will be probably no, these tests are expensive and where healthcare is not free or rich countries all these tests are not used
ultrasound, tomography, MRI, they all cannot see liver damage and fibrosis, but only nodules and cancers
fibroscan and biopsy are the only ones to see fibrosis and liver damage, at 53yo you have fibrosis for sure unless been infected recently, but in asia you get it mostly at birth
so my suggestion is do make biopsy at least you know what your liver damage is, there is no other way to tell