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Will Viread help splenomegaly and portal hypertension
I've consistently had mild splenomegaly (14 cm), mild dilation of main portal vein (15 mm) that enhances normally, and low wbc count. I am told correlates with mild portal hypertension (my platelet count is always good around 225-250 and rbc count good). These findings have all been stable but constant for 10+ years (from 6 month ultrasound, CT, MRI, biopsies). I'm told I do not have cirrhosis or ascites. I am hbeag negative, with lower end viral load (never more than 1300 iu/ml when tested), ALT around 25-34. I started Viread 3 months ago due to age and length of infection. After 2 months my VL was detected but <20 iu/ml. I'm hoping in a few weeks when tested I will be UND. I'm also scheduled for a Fibroscan in September.
I know Viread helps regress cirrhosis, so will the Viread help regress the splenomegaly, dilation of portal vein, and raise wbc count? I have tried reading about these issues (and they all sound very bad to me but told okay by several hepatologists since stable for so long) but cannot find anything on Viread and these issues combined (only find cirrhosis).
Thank you for any help or specific studies to read
I know Viread helps regress cirrhosis, so will the Viread help regress the splenomegaly, dilation of portal vein, and raise wbc count? I have tried reading about these issues (and they all sound very bad to me but told okay by several hepatologists since stable for so long) but cannot find anything on Viread and these issues combined (only find cirrhosis).
Thank you for any help or specific studies to read
I do drink coffee and often do before scans, since I'm usually fasting but allowed to drink water and black coffee. I will keep that in mind.
I will also ask about and try to obtain the other procedures. Thank you for your help.
I will also ask about and try to obtain the other procedures. Thank you for your help.
These biopsies speak indeed against vascular or fibrotic damage that could explain a portal circulation resistance increase, leading to portal hypertension.
there are a few more esoteric reasons for portal hypertension, like hepatic vein restriction, but we need not consider this here.
So maybe you do not have portal hypertension, just splenomegaly and a relatively wide portal vein. If you eat or drink coffee before the ultrasound, the portal vein also expands.
But the definite answer lies in the gastroscopy or wedged pressure measurement, as i mentioned before, so try to get that. If you complain about intense reflux disease, you can easier get a gastroscopy, since one tries to exclude Barretts esophagus.
there are a few more esoteric reasons for portal hypertension, like hepatic vein restriction, but we need not consider this here.
So maybe you do not have portal hypertension, just splenomegaly and a relatively wide portal vein. If you eat or drink coffee before the ultrasound, the portal vein also expands.
But the definite answer lies in the gastroscopy or wedged pressure measurement, as i mentioned before, so try to get that. If you complain about intense reflux disease, you can easier get a gastroscopy, since one tries to exclude Barretts esophagus.
I have copies of everything since 2003. I want to post pictures of exact copies but do not know how. I typed the reports, ugh.
In 2003 the biopsy says:
Normal lobular architecture appears to be well maintained. Terminal hepatic vein appear unremarkable. Most portal triads are unremarkable with only a rare portal triad showing a minimal increase in chronic inflamatory cells. Occasional minute foci of lobular chronic inflamation are appreciated, rarely without apoptosis. Occasional deposits of PAS positive, diastase resistant material ate identified within Kupffer cells in the lobules indicating old hepatic dropout. There is no acute viral induced effect, acute inflamation, granuloma formation, localized lesion, dysplasia. There is clearly no bridging or fibrosis. There is no interferance hepatitis. Final diagnosis was chronic hepatitis with minimal activity and minimal fibrosis.
In 2014 I had another biopsy interpreted at Mayo. They say:
The portal areas show no significant inflammation. Bile ducts are unremarkable without significant reactive changes or inflammation. The terminal branches of the portal veins and hepatic arteries are unremakable. The interface zone is negative for significant ductular reaction or necroinflammatory activity. The lobules are intact without significant stetosis, inflammation, sisusodial dialation, or pigment deposition. Central veins are unremarkable. The trichrome stain highlights the lack of fibrosis. A reticulin stain highlights the hepatic plate architecture. An iron stain is negative. Conclusion: sections show a generous needle core biopsy of hepatic parenchyma for examination. The lobular architecture of the liver is in tact with alternating portal tracts and central veins with normal spacing. There is no significant portal fibrosis.
Does this help? Thanks!
In 2003 the biopsy says:
Normal lobular architecture appears to be well maintained. Terminal hepatic vein appear unremarkable. Most portal triads are unremarkable with only a rare portal triad showing a minimal increase in chronic inflamatory cells. Occasional minute foci of lobular chronic inflamation are appreciated, rarely without apoptosis. Occasional deposits of PAS positive, diastase resistant material ate identified within Kupffer cells in the lobules indicating old hepatic dropout. There is no acute viral induced effect, acute inflamation, granuloma formation, localized lesion, dysplasia. There is clearly no bridging or fibrosis. There is no interferance hepatitis. Final diagnosis was chronic hepatitis with minimal activity and minimal fibrosis.
In 2014 I had another biopsy interpreted at Mayo. They say:
The portal areas show no significant inflammation. Bile ducts are unremarkable without significant reactive changes or inflammation. The terminal branches of the portal veins and hepatic arteries are unremakable. The interface zone is negative for significant ductular reaction or necroinflammatory activity. The lobules are intact without significant stetosis, inflammation, sisusodial dialation, or pigment deposition. Central veins are unremarkable. The trichrome stain highlights the lack of fibrosis. A reticulin stain highlights the hepatic plate architecture. An iron stain is negative. Conclusion: sections show a generous needle core biopsy of hepatic parenchyma for examination. The lobular architecture of the liver is in tact with alternating portal tracts and central veins with normal spacing. There is no significant portal fibrosis.
Does this help? Thanks!
You need to establish if you really have mild portal hypertension.
It is the result of damaged vascular micro architecture in the liver lobules, typically combined with severe fibrosis. But you had biopsies, whose detailed results you should have shown when posting this question.
You should get a gastroscospy, it will show mild varices of the esophagus and other signs of portal hypertension in the stomach mucosa.
The mayo clinic should also be able to make a definite diagnosis by measuring the wedged hepatic vein pressure, it will directly indicate the actual pressure in your portal system.
Normally, with fibrosis regression from not too advanced stages of cirrhosis, the damaged vascular architecture also improves.
Thus fibroscan and fibro test to define fibrosis stage are needed together with the procedures mentioned, to further clarify this issue. The normal ultrasound and mri are not very relevant.
History of other liver damaging life styles and events like obesity, alcoholism or bad food habits are to be considered.
Spleen sizes in the last 15 years of ultrasound monitoring have had what values? I assume you obtain a copy of all test reports for your personal file?
It is the result of damaged vascular micro architecture in the liver lobules, typically combined with severe fibrosis. But you had biopsies, whose detailed results you should have shown when posting this question.
You should get a gastroscospy, it will show mild varices of the esophagus and other signs of portal hypertension in the stomach mucosa.
The mayo clinic should also be able to make a definite diagnosis by measuring the wedged hepatic vein pressure, it will directly indicate the actual pressure in your portal system.
Normally, with fibrosis regression from not too advanced stages of cirrhosis, the damaged vascular architecture also improves.
Thus fibroscan and fibro test to define fibrosis stage are needed together with the procedures mentioned, to further clarify this issue. The normal ultrasound and mri are not very relevant.
History of other liver damaging life styles and events like obesity, alcoholism or bad food habits are to be considered.
Spleen sizes in the last 15 years of ultrasound monitoring have had what values? I assume you obtain a copy of all test reports for your personal file?
Thanks Stef. One Hepatologist showed me on my MRI and CT scans where my anatomy was causing the presumed mildly enlarged portal vein and splenomegaly, suggesting that they are not liver issues due to anatomy? He also said with so many scans (every 6 months) in 10+ year, labs, and 2 biopsies said for sure no cirrhosis?
One more question. What is the difference between a transient elastography and a Aixplorer ShearWave Elastography? I'm scheduled for the transient elastography in Sept. but have the option for the other at another facility. I read about both and they sound different. Which do you feel is better or should I try both? Thanks!
One more question. What is the difference between a transient elastography and a Aixplorer ShearWave Elastography? I'm scheduled for the transient elastography in Sept. but have the option for the other at another facility. I read about both and they sound different. Which do you feel is better or should I try both? Thanks!
i d check fibroscan to know for sure how liver is, i am not very expert on advanced decompensated cirrhosis but portal hypertension happens when we have problems with blood flow in the liver and i guess we need damage for this to happen
raw organic cocoa beans, berries over 160g per day and organic black rise do help.if fibrosis is elevated also heptech and maxhealthlabs liposomes are helpful
raw organic cocoa beans, berries over 160g per day and organic black rise do help.if fibrosis is elevated also heptech and maxhealthlabs liposomes are helpful
Thanks. The weird thing is that I'm consistently told I don't have cirrhosis, but don't understand why the mild portal hypertension and mild Splenomegaly?
I find so much info on treatment and cirrhosis but cannot find anything on spleen or portal hypertension. I hope it helps and hope your uncle continues to do well!
I find so much info on treatment and cirrhosis but cannot find anything on spleen or portal hypertension. I hope it helps and hope your uncle continues to do well!
i hope you can achieve some kind of regression after starting tenofovir. My uncle had really bad cirrhosis and it is currently under control or regressing.
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