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Biopsy results
I became infected with hepatitus c back in 1995. I did have a liver biopsy in 98. Now about 2 months ago I was taken to hospital because of diabetes and they found out I had a fatty liver and they claimed they tested my blood NO HEP C found. I was told I had NASH which is NON alcoholic liver disease. I had a biopsy done these are the results. Could HEP C have done this even though it cleared itself? I was told in 98 after a biopsy that I had mild to moderate inflammation in my liver.
Biopsy is somewhat fragmented, but it appears to have at least some fibrous expansion of portal tracts, possibly with fibrous bridging. Definitive changes of cirrhosis are NOT evident, however, there is marked macrovesicular and microvesicular steatosis involving 70-80 % of the liver parenchyma, without a specific distrubution. Neutrophils are few, but lymphoctes are noted and hepatocyte ballooning is evident. Hemosiderosis is absent as demonstrated by an iron stain and eosinophilic globules typical of alpha -1-antitrysin deficiency are not observed on PASD staining.
Biopsy is somewhat fragmented, but it appears to have at least some fibrous expansion of portal tracts, possibly with fibrous bridging. Definitive changes of cirrhosis are NOT evident, however, there is marked macrovesicular and microvesicular steatosis involving 70-80 % of the liver parenchyma, without a specific distrubution. Neutrophils are few, but lymphoctes are noted and hepatocyte ballooning is evident. Hemosiderosis is absent as demonstrated by an iron stain and eosinophilic globules typical of alpha -1-antitrysin deficiency are not observed on PASD staining.
There are issues with bloating and liver disease, but I believe that this happens when your disease is much more advanced. I don't know much about it, but someone with more knowledge will offer their experience I am sure.
I would tell your doctor about it to insure you don't have any fluid in your abdomen area (Ascites). Again from what I have read this usually happens when you have cirrhosis. I don't know if it can happen earlier
Be Well - Dave
I would tell your doctor about it to insure you don't have any fluid in your abdomen area (Ascites). Again from what I have read this usually happens when you have cirrhosis. I don't know if it can happen earlier
Be Well - Dave
Thank you so much for what you wrote to me. It has helped me alot. I do have one more question. I am having alot of bloating in my stomach and do not feel like eating is this something I should tell my doctor about? or is it something that will go away?
I forgot to mention. Often people do not feel sick until their liver disease is very advanced, I mean well into the cirrhosis stage. It's different for everyone of course. Some people don't feel sick until they have decompensated cirrhosis (liver no longer can function, or barley functioning) at this point they will need a transplant to survive. You are no where close to that point of course.
- Dave
- Dave
Hi-
As you mentioned you have stage two (periportal fibrosis) to stage three (bridging fibrosis) out of four, stage 4 is early compensated cirrhosis (your liver still functions properly for the most part, but you have a lot of scarring). There are people who have lived with compensated cirrhosis for a very long time, some as long as 10-20 years. If you have hep c, it would generally take a person 20-40 years to get to stage 4, possibly longer and with some, never.
it's hard to determine how long a person will move through these stages, but it doesn't generally happen quickly as bill mentioned. Nash can definitely cause the same kind of damage to your liver as hep c or alcoholic liver disease. The only treatment currently is to get to a healthy weight, exercise, and to eat a healthy diet low in sugar and fat. There are medications being investigated for the treatment of nash.
I know it's scary. I also have steatosis of the liver and stage 2-3, but I have had hep c for thirty years which predisposes you to it even more. When I found out I had some steatosis I changed my eating habits, lost 50 lbs and starting exercising a lot. During the previous 5-6 years I had put on a lot weight which I am convinced added to this problem. I was never so aware (although I should have been) as I am now, how being overweight can seriously effect your health.
Be Well - Dave
Here is some information about Nash. I hope it helps explain, you may have already read about it.
http://digestive.niddk.nih.gov/ddiseases/pubs/nash/
Nonalcoholic steatohepatitis or NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.
NASH affects 2 to 5 percent of Americans. An additional 10 to 20 percent of Americans have fat in their liver, but no inflammation or liver damage, a condition called “fatty liver.” Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver.
Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. Diabetes and high blood cholesterol are also becoming more common among Americans.
Biliary system.
[Top]
Diagnosis
NASH is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NASH is suspected. The only means of proving a diagnosis of NASH and separating it from simple fatty liver is a liver biopsy. For a liver biopsy, a needle is inserted through the skin to remove a small piece of the liver. NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. If the tissue shows fat without inflammation and damage, simple fatty liver or NAFLD is diagnosed. An important piece of information learned from the biopsy is whether scar tissue has developed in the liver. Currently, no blood tests or scans can reliably provide this information.
As you mentioned you have stage two (periportal fibrosis) to stage three (bridging fibrosis) out of four, stage 4 is early compensated cirrhosis (your liver still functions properly for the most part, but you have a lot of scarring). There are people who have lived with compensated cirrhosis for a very long time, some as long as 10-20 years. If you have hep c, it would generally take a person 20-40 years to get to stage 4, possibly longer and with some, never.
it's hard to determine how long a person will move through these stages, but it doesn't generally happen quickly as bill mentioned. Nash can definitely cause the same kind of damage to your liver as hep c or alcoholic liver disease. The only treatment currently is to get to a healthy weight, exercise, and to eat a healthy diet low in sugar and fat. There are medications being investigated for the treatment of nash.
I know it's scary. I also have steatosis of the liver and stage 2-3, but I have had hep c for thirty years which predisposes you to it even more. When I found out I had some steatosis I changed my eating habits, lost 50 lbs and starting exercising a lot. During the previous 5-6 years I had put on a lot weight which I am convinced added to this problem. I was never so aware (although I should have been) as I am now, how being overweight can seriously effect your health.
Be Well - Dave
Here is some information about Nash. I hope it helps explain, you may have already read about it.
http://digestive.niddk.nih.gov/ddiseases/pubs/nash/
Nonalcoholic steatohepatitis or NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.
NASH affects 2 to 5 percent of Americans. An additional 10 to 20 percent of Americans have fat in their liver, but no inflammation or liver damage, a condition called “fatty liver.” Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver.
Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. Diabetes and high blood cholesterol are also becoming more common among Americans.
Biliary system.
[Top]
Diagnosis
NASH is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NASH is suspected. The only means of proving a diagnosis of NASH and separating it from simple fatty liver is a liver biopsy. For a liver biopsy, a needle is inserted through the skin to remove a small piece of the liver. NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. If the tissue shows fat without inflammation and damage, simple fatty liver or NAFLD is diagnosed. An important piece of information learned from the biopsy is whether scar tissue has developed in the liver. Currently, no blood tests or scans can reliably provide this information.
Bill
you said it takes decades to produce the damage like this. I am not understanding the liver biopsy is that what basically it is saying I have alot of damage already? I am sorry if I am coming across cold I was just told all this not even a month ago and still in shock that I have this wrong with my liver. I been feeling fine and now all of a sudden I am told I am in between 2 and 3rd stage liver disease and there are only 4 stages and yes it is frightening.
I am part of a discussion group concerning the diabetes I was just wanting to know basically what my liver results meant thats all. Thats why I placed the results on here.
Thanks for everything it is appreciated Bill
Penny
you said it takes decades to produce the damage like this. I am not understanding the liver biopsy is that what basically it is saying I have alot of damage already? I am sorry if I am coming across cold I was just told all this not even a month ago and still in shock that I have this wrong with my liver. I been feeling fine and now all of a sudden I am told I am in between 2 and 3rd stage liver disease and there are only 4 stages and yes it is frightening.
I am part of a discussion group concerning the diabetes I was just wanting to know basically what my liver results meant thats all. Thats why I placed the results on here.
Thanks for everything it is appreciated Bill
Penny
Thanks Penny. No, I caught that initially, although I might not have displayed that as well as I could have. I listed the type II DM forum only because I didn’t see a endocrinology or DM I doctor-supported discussion group; it was the closest to appropriate forum I could locate at quick glance. By all means, if you see one more fitting, certainly use it.
I still think it’s a stretch to attribute this to HCV; it generally takes decades to produce the damage like this. However, there certainly are exceptions; and I’m far from a health care professional.
Good luck; diabetes and metabolic syndrome are no fun… I’m dealing with both, and am very sympathetic, if nothing else :o). I’ve also dealt with pretty significant liver disease; it’s all frightening.
Very best regards,
Bill
I still think it’s a stretch to attribute this to HCV; it generally takes decades to produce the damage like this. However, there certainly are exceptions; and I’m far from a health care professional.
Good luck; diabetes and metabolic syndrome are no fun… I’m dealing with both, and am very sympathetic, if nothing else :o). I’ve also dealt with pretty significant liver disease; it’s all frightening.
Very best regards,
Bill
One more thing I AM NOT a type 2 diabetic. I am a type 1.5 which is late onset type 1 diabetes. Because of the pancreas working a little they thought I was a type 2 till blood test revealed I was actually a late onset adult type 1. They are learning adults can have type 1 diabetes and not be diagnosed till later in life and thats what happened with me
take care
bye
take care
bye
Yes, Penny; you can click on the link below and look on the right, under ‘ask a doctor’ forums:
http://www.medhelp.org/forums/list?camp=sub_nav
They do have a diabetes type II forum, although I know nothing about the doc there. The HCV professional forum is now defunct, to me knowledge.
This is fascinating; but as you know, there are only patients in this group. Good luck; if you have time, keep me posted, and good luck, okay?
Bill
http://www.medhelp.org/forums/list?camp=sub_nav
They do have a diabetes type II forum, although I know nothing about the doc there. The HCV professional forum is now defunct, to me knowledge.
This is fascinating; but as you know, there are only patients in this group. Good luck; if you have time, keep me posted, and good luck, okay?
Bill
We do not know what has caused my liver disease. That is what the doctor is trying to find out now. We know I was infected with HEP C in 95 and I had VERY high levels of alt and ast blood work but then was treated with interferon for 3 months and everything came back to normal BUT there was still mild to moderate inflammation in the liver in 98 now was this due to the HEP C?? because in 98 I did NOT have diabetes I was only diagnosed with diabetes in 2004.
I have type 1.5 LATE ONSET ADULT TYPE 1 DIABETES. They thought I had type 2 until they did some blood work and checked my pancreas and then they realized I was a late onset type 1 diabetic and actually had symptoms of type 2. They just took me off 500 mg of metformin twice a day because it did nothing for me.
I was infected and my body cleared it but it did leave mild to moderate inflamation in my liver and I was on a drug called interforon for 3 months and then taken off, so yes less than 6 months I had it but appearently it did some damage or there would never have been mild to moderate inflammation in the liver in 98
I am wondering are there medical professionals on this site who answer our questions?
I have type 1.5 LATE ONSET ADULT TYPE 1 DIABETES. They thought I had type 2 until they did some blood work and checked my pancreas and then they realized I was a late onset type 1 diabetic and actually had symptoms of type 2. They just took me off 500 mg of metformin twice a day because it did nothing for me.
I was infected and my body cleared it but it did leave mild to moderate inflamation in my liver and I was on a drug called interforon for 3 months and then taken off, so yes less than 6 months I had it but appearently it did some damage or there would never have been mild to moderate inflammation in the liver in 98
I am wondering are there medical professionals on this site who answer our questions?
Whooo, that’s a lot of insulin, huh?
Yeah, yeah I get it; the insulin causes weight gain, which causes additional insulin resistance which causes you to take more insulin, which causes…..
And in your case, it also contributes to liver disease.
If you don’t have DM type II, have they explained why you have so much insulin resistance? I’m type II, and always thought type I didn’t normally have issues with IR?
I had to use 110 units Lantus in one sitting while doing my HCV therapy; it was a drag, but after I completed the treatment I no longer require insulin; only oral antidiabetic drugs. Have they considered adding an insulin senstizer like Metformin to the mix? I think it works on exogenous insulin as well as the stuff we produce?
I’m not sure HCV is the culprit here; if you were infected, it would have been for less than six months, right?
Bill
Yeah, yeah I get it; the insulin causes weight gain, which causes additional insulin resistance which causes you to take more insulin, which causes…..
And in your case, it also contributes to liver disease.
If you don’t have DM type II, have they explained why you have so much insulin resistance? I’m type II, and always thought type I didn’t normally have issues with IR?
I had to use 110 units Lantus in one sitting while doing my HCV therapy; it was a drag, but after I completed the treatment I no longer require insulin; only oral antidiabetic drugs. Have they considered adding an insulin senstizer like Metformin to the mix? I think it works on exogenous insulin as well as the stuff we produce?
I’m not sure HCV is the culprit here; if you were infected, it would have been for less than six months, right?
Bill
I have late onset ADULT type 1 diabetes which is also called type 1.5 diabetes.
I had very little of my pancreas working when I was born.
Nash was diagnosed only 2 months ago but back in 98 I had liver results that were high that caused them to do the first biopsy. The biopsy just done in May was due to a fatty liver seen on a cat scan. Yes I am overweight and I have tried to lose weight to know avail I have metabolic syndrome the weight problem began when I went from thru hormonal changes from teen to adult hood.
I take 70 units of Levemir in the Morning and 70 units at night and then I also take 30 units of Novolog at each meal 3 times a day and before bedtime. The high amount of insulin has NOT helped my weight at all in fact I have gained 60 pounds since starting this regiment.
I had very little of my pancreas working when I was born.
Nash was diagnosed only 2 months ago but back in 98 I had liver results that were high that caused them to do the first biopsy. The biopsy just done in May was due to a fatty liver seen on a cat scan. Yes I am overweight and I have tried to lose weight to know avail I have metabolic syndrome the weight problem began when I went from thru hormonal changes from teen to adult hood.
I take 70 units of Levemir in the Morning and 70 units at night and then I also take 30 units of Novolog at each meal 3 times a day and before bedtime. The high amount of insulin has NOT helped my weight at all in fact I have gained 60 pounds since starting this regiment.
Hi Penny—
Sorry to hear you’re having troubles. The definitive test for active RNA virus is the ‘HCV RNA by PCR’ test. You might want to verify this, or a similar NAT test was performed at the hospital to make sure there was no active disease present.
About 15-20% of those exposed and infected with acute HCV will clear the virus within six months of exposure; it’s quite possible this was the case with you.
Can you tell me why, if you cleared the virus spontaneously, they performed a liver biopsy? It’s not important to your question, I’m just curious. Was this procedure ordered because of the NASH diagnosis?
The biopsy report clearly states that fatty liver (steatosis) was present; are you overweight/obese?
This could explain the diabetes, assuming you have type II?
What steps are the doctors taking to help you manage this?
Bill
Sorry to hear you’re having troubles. The definitive test for active RNA virus is the ‘HCV RNA by PCR’ test. You might want to verify this, or a similar NAT test was performed at the hospital to make sure there was no active disease present.
About 15-20% of those exposed and infected with acute HCV will clear the virus within six months of exposure; it’s quite possible this was the case with you.
Can you tell me why, if you cleared the virus spontaneously, they performed a liver biopsy? It’s not important to your question, I’m just curious. Was this procedure ordered because of the NASH diagnosis?
The biopsy report clearly states that fatty liver (steatosis) was present; are you overweight/obese?
This could explain the diabetes, assuming you have type II?
What steps are the doctors taking to help you manage this?
Bill
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