pathological diagnosis

[stonewall611]

I had a random liver biopsy:  -Chronic hepatitis consistent with hepatitus C, with mild activity (grade2) with bridging fibrosis and area consistent with evolving cirrhosis (stage3-4).   -  An iron stain shows midly increased itrahepatocytic iron (grade1).   -  Mild steatosis (grade1).   -  Reticulin and trichrome stains support the diagnosis.   PAS-diastase stain shows no abnormalities.

I found this difficult to type as sentences (copy),  let alone understand.  And my GI talks down to me when I ask questions, so I am reluctant to do so.  Does this mean I have cirrhosis or liver damage turning into cirrhosis? (evolving).   I find myself very worried about haveing my GI treat me for HCV considering our present  uncomfortable repoir and could use your explanation and advise.

[Captnj]

Hi, I would try to find a doctor that can talk to you so that you understand. This site is full of people who understand what you are going through. I thought that I could wait to treat my hep c and really was scared from watching a good friend of mine do treatment. I'm sure you have heard the stories of how difficult treatment is but if I could go back in time I would do it in a minute. I'm diabetic,obese,with high blood pressure and cirrhosis so I have to watch everything I do. The weight seems to be my biggest issue now because If I don't loose weight I can't get a liver transplant. I was worried about work and I had given up on diets and felt hopeless so I understand what you are going through. I take an anti-depressant and I believe that it helps. Acceptance of your disease is a good first step. Try to stay positive. Surround yourself with people that understand and get through 1 day at a time. I would treat the hep c as soon as possible. After you clear the virus you can live a long wonderful life. the longer you wait to treat the worse things can get. My doctors have told me that because of my other problems that I can't start treatment yet. Now I'm racing the clock hoping my liver doesn't quit on me before I can loose weight and try to either treat or transplant my liver. I also take a sleeping pill to help me sleep. With all of this stuff hitting you it is normal not to be able to sleep. Again find a doctor that cares enough to talk to you and who wants to help you get better. Also if you see more than 1 doctor keep all of them up to date with what the others are doing. It's like a team approach. They say 2 heads are better than 1 and have found in my case it works good. Sorry so long winded. Hang in there, there is hope. You can recover.

[newleaf09]

Your biopsy is not good. You are verging on cirrhosis (mine said "probable or incipient cirrhosis), have a layer of fat (steatosis) and are storing iron.  None of this is good.  My doc says though that the policy for pathologists is that if you have doubts, always give worse interpretation so patient sees the most serious possiblity.  Removing the virus from the cells will allow healthy cells to replace them and if you clear the virus so the new cells don't get reinfected, your liver will repair itself after treatment if you don''t go back to putting stress on it again.  A reversal of 2 stages of fibrosis would make you feel assured that you will lead a normal life.

Treatment is very intense and I personally need to get emotional support from my medics.  If you can't find a hepatologist, switch GI's so you get someone who can take the time to talk to you and reassure you through treatment.

[JennyPenny]

I totally agree with what jmjm says. However, the part about hepatologists is not realistic for everyone. Unfortunately there are vast areas of our country that have no hepatologists available. They can usually be found in large cities with academic centers. Not all Gastros are bad. Mine is fabulous and so are some I have heard speak at the large seminars.So don't panic if you are not able to find a hepatologist. AASLD has a physician locator on their site. Tht will help you see who is available in your area of the country.

[jmjm530]

I'm assuming the reason for your "random liver biopsy" was that you tested positive for the Hepatitis C virus? The definitive test is called a viral load test, sometimes referred to as a PCR.

Based on what you describe, you are between stage 3 and 4 which means time to seriously consider treatment. You should know that treatment can halt or even reverse liver damage in many cases.

As to your doctor, your worries are correct. Collect all your medical records and make an appointment with a hepatologist (liver specialist) at a large, teaching hospital. They have far more experience in both evaluating and treating HCV than gastro's. You also might want to bring your originial biopsy slide set with you in addition to the biopsy report so the liver specalist's pathologist can give another read.