liver biopsy

Question

I just got my liver bio back.. inflammation grade 2; fibrosis stage 4????  How bad is my liver?

hcvJames · Accepted Answer

I'm a little confused (always) it would seem the higher the stage the greater the grade? Doesn't the fibrosis increase the inflammation? If not, then they are two separate actions. Guess I just don't understand what inflammation is. Isn't stage 4, cirrhosis? How is cirrhosis measured? Thanks for any reply.

Richpasq : When I was told I had stage 4 liver disease I asked how many stages are there. The answer was 4. Knowing absolutely nothing else it took about 30 seconds to get over the immediate shock and ask what can be done. That's where you are now. Need advice, explanations, support, or just want to vent, you've come to the right place. Many knowledgeable persons like copyman have been through it all. And it's an active forum. There are long promised new drugs coming out April, May or June, you can prolly afford to wait that long, personally I wouldn't wait beyond that, that's just me thou. If you drink alcohol, stop NOW. It is pure poison to your liver.
All the best and welcome to the group.

RICHPASQ · Answer

Thanks for all the input from everyone.  I am new to this site and I'm happy to see this is an active forum.  Just to answer a few questions.  I did have an endoscopy to check for varices
and there were none.  I have elevated AFP 61 (TUMOR MARKERS).MRI shows no cancer! platelets are a bit low.  Bilirubin is ok.  AST & ALT are 2x above normal. My Genotype is 1.
I get very tired a lot and my joints hurt.  Memory is shot anymore... Can't work!!  Do I qualify for SSD or SSI??  I did not start treatment yet and from what I hear its no walk in the park.

Ozgirl707 · Answer

It's frightening at first, but get treated and hopefully you'll kill the virus.

It'd be good to know what genotype you are.

 My hubby was cirrhotic with type 2  HCV. He treated and is now virus free and his liver is actually healing well !!!!

Living a healthy lifestyle is SO important.

Good luck, try not to stress too much,

~ Ozgirl

GoofyDad · Answer

I know what a blow this is because it happened to me in summer of 2005. My son was just finishing first grade. Now he's in middle school, playing baseball and basketball, my hcv is gone and my liver seems to be improving. 

Time will help you adjust to this new information. New drugs are on the way - this is not a death sentence.

paen53 · Answer

Tough news about the Stage 4. I remember the day well that I heard those words - very sobering. But, you now know where you stand, can take action and move forward. I think it's very important to have someone that has plenty of experience with cirrhosis as far as Drs go. They will be aware of the options you have to give tx your best chance at beating the virus. You'll want someone that will compare your bx results with bloodwork that can support these findings - tests like platelets, INR, bilirubin, albumin, some kidney function tests. You will most likely be recommended to have an endoscopy to check for varices and some imaging as well. These tests will help determine if your liver is compensated or decompensated before tx is determined. 

Have they determined your Genotype yet? You'll probably feel a bit in information overload, so it's good to write down any questions you have before your next appointment. And ask that your Dr. answer them in a way that is clear to you. Another set of ears can be good too. 

Best wishes in going forward, Pam

eureka254 · Answer

Starting treatment soon is the best proactive route, being a Stage 4.  Liver biopsy measures Grade, which assesses inflammation, and Stage, which reflects the level of scarring, or fibrosis.  Grade can vary from one biopsy to another in the same person -- inflammation, the result of the liver's response to viral activity, can go up or down; Stage, however, usually goes in one direction, from 0, which means no scarring or fibrosis, to 4, which is severe fibrosis, synonymous with cirrhosis.  Biopsy can also detect cellular differences, and steatosis is the technical term for fatty liver, which is fairly common in advanced liver disease.  (My husband is also a Stage 4 and has mild steatosis as well.) Hope that helps.

hcvJames:  Inflammation contributes to fibrosis, but inflammation itself in the setting of liver disease is somewhat independent of Stage.  They are correlative actions, and though higher grade increases the likelihood of fibrosis, higher Stage does not necessitate more inflammation: for example, a cirrhotic could clear the virus and thereby eliminate inflammation but still be left with Stage 4.

RICHPASQ · Answer

I have not treated HCV but going to start soon! I'm not sure what the inflammation grade 2 with moderate steatosis means?? I realize stage 4 fibrosis is not good. Just wondering if stage 4 fibrosis and stage 4 cirrhosis is one and the same? My GI doc did not explain any of this to me. Any input on this will be helpfull.

copyman · Answer

sorry to say stage 4 is on the bad end of the scale, 1 being little damage and 4 being the worse. Hopefully you are catching it in the early part of stage 4. Have you treated the HCV? You should try and treat or re-treat ASAP. If you are not seeing a Hepatologist (liver specialist) then you should look to treat with one.
Best of luck