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Ultrasound Abdomen complete with Doppler
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Ultrasound Abdomen complete with Doppler

6857766?1303841132
I was hoping that some of you wouldn't mind taking the time to read over the results of this test and tell me you interpretation. I would really appreciate it.

Thank You, Randy
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419309_tn?1326506891
Hi Randy,

Overall, your ultrasound is very much in line with cirrhosis:
"heterogenous echotexture" is consistent with cirrhotic tissue, no surprises there.'
"without masses" is excellent: means no tumors or hcc, which is a risk for cirrhotics.
"patent ... veins... no ascites" is all good news, means there's no blood obstruction and no fluid build up.
"coleilthiasis" just means you have gallstones..."splenomegaly" means you have an enlarged spleen, but not unexpected with cirrhosis ... very consistent with your low platelets.  

It is very important for folks with cirrhosis to have ultrasound imaging at least every 6 months along with AFP testing for HCC surveillance, and your ultrasound does show that there is no concern there :).  Hope my unprofessional opinion was some help.  ~eureka
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419309_tn?1326506891
Hi Randy,

Overall, your ultrasound is very much in line with cirrhosis:
"heterogenous echotexture" is consistent with cirrhotic tissue, no surprises there.'
"without masses" is excellent: means no tumors or hcc, which is a risk for cirrhotics.
"patent ... veins... no ascites" is all good news, means there's no blood obstruction and no fluid build up.
"coleilthiasis" just means you have gallstones..."splenomegaly" means you have an enlarged spleen, but not unexpected with cirrhosis ... very consistent with your low platelets.  

It is very important for folks with cirrhosis to have ultrasound imaging at least every 6 months along with AFP testing for HCC surveillance, and your ultrasound does show that there is no concern there :).  Hope my unprofessional opinion was some help.  ~eureka
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Avatar_m_tn
Again, Eureka summed it up better than I would have.

Good luck,
Mike
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1475202_tn?1388955435
Eureka, Thank you for looking at the results for me. I love to hear what others think also. I will take your opinion as professional since you basically said the same thing as my doctor. ha ha I asked him what more can I be doing to help this poor liver and he just said keep doing what you have been. I'm growing impatient! ha ha It's been 13 months is more recovery still possible? I feel like now i'm at a point where im stuck with portal hypertension due to the scaring in my liver.

I had blood drawn today because it's been nearly 3 months since those labs. I totally soaked through the cotton swab they tape on and had to use a napkin for the ride home.thats got to be the low platlette count stopping the clotting. I take vit C every day so that should be helping.

I do suffer quite a lot with HE my doctor even suspects brain damage. I take xifaxan but its just not enough. I dont really feel any dumber unless i forget somethig or get confused. . Well now im getting confused why im just going on and on. lol

Thank you again Eureka and Mike.

Randy
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Avatar_m_tn
The possibility and extent of histological improvement in a patient with cirrhosis due to alcoholism confuses me.
Generally the literature states that alcohol induced cirrhosis is not reversible. But, until recently that was the prevailing opinion with cirrhosis caused by any insult or injury, be it viral or toxic or auto-immune.
Some new data suggests that some patients with cirrhosis due to hepatitis c who achieve a sustained viral response (cure) will regress a stage and possibly more - they improve from cirrhosis to fibrosis. Now, what intrigues me is that, as I understand it, cirrhosis is an architectural description - it refers to scar tissue and scar tissue is scar tissue irrespective of the cause.
Why is it possible for a Hep C cirrhotic patient to improve when the offending injury (the virus) is eliminated but it's not possible for an alcoholic patient who stops drinking to improve his liver histology?
I guess my opinion regarding whether your liver can improve and, if so, how much, is that I don't really know, I choose to be optimistic and continue to hope. I never see the downside of hope. People often advise others to prepare for the worst. I reject that notion completely because the truth is we are never prepared for the worst. If it comes we will deal with it but there is no upside to living in a negative mind space by expecting the worst. Stay hopeful and expect the best.

Good luck Randy,
Mike
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1475202_tn?1388955435
Mike, from what I have read is that cirrhosis is reversable unless you have reached the final stage. So to me being diagnosed with the final stage a certain amount of scar tissue must be required to prevent apropriate blood flow.. I don't really see how this can be measured acurately unless the amount of blood flow through the liver could be measured. A test I never had. Even with a liver biopsy diagnosis of the stage could very from what portion of the liver is taken from.

Perhaps the degree of portal hypertension can be messured by what grade of varacies a patient has. I have grade 3 and they have not made a change in since the first endoscopy approx. 13 months ago.
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Avatar_m_tn
They can measure portal hypertension pretty accurately but the procedure is involved and the equipment is specialized so the procedure is not generally available.

"Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as a guide for prophylaxis and therapy of bleeding and rebleeding? No.

Thalheimer U, Bellis L, Puoti C, Burroughs AK.
Source

The Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
Abstract

Portal hypertension (PH) is a severe complication of liver cirrhosis. Measurement of the degree of portal hypertension is usually performed by measuring the hepatic venous pressure gradient (HVPG) which is the difference between the free hepatic venous pressure (FHVP) and the wedged hepatic venous pressure (WHPG). The HVPG accurately reflects the degree of PH in the majority of liver diseases. PH is defined by an increase of HVPG values above the normal upper limit of 5 mm Hg, while clinically significant PH is defined by an HVPG to ≥10 mm Hg. Although measurement of HVPG potentially has several applications, in clinical practice its major use has been related to the assessment of hemodynamic response to pharmacological therapy, in order to evaluate the efficacy of treatment and to predict the risk of rebleeding from esophageal varices. When properly performed, HVPG is a reliable, safe and good predictive tool in the management of portal hypertension. However, the need for appropriate equipment, sufficient and reliable operators and costs, have discouraged its use outside Liver Units specifically devoted to the clinical management of portal hypertension. This has diminished its applicability. Combining its use with transjugular liver biopsy and using the prognostic value of HVPG may help encourage its use."

http://www.ncbi.nlm.nih.gov/pubmed/21238884
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419309_tn?1326506891
mikesimon:  Thank you for the endorsement :).

rpooo:  I too have heard doctors say that 'early' cirrhosis is reversible, but it seems to be a bit murky exactly what constitutes 'early.'  There appears to be in cirrhotic progression a point of no return, but exactly when a liver becomes unable to regenerate itself is unclear.  The important thing to keep in mind is that removing the insult or injury (viral infection, alcohol, etc.) to the liver should prevent further damage, independent of reversal.

As mikesimon posted above, it is possible to measure portal pressure directly via transjugular biopsy.  My husband did have the procedure done a couple of years ago (my impression was that it is a highly specialized physician) and was put on nadolol as a preventative for borderline portal hypertension; however, if you have existing varices, it may be little utility to pursue measuring hepatic pressures.  With continued sobriety, the expectation would be that hypertension would not progress further.  No change in 13 months where that's concerned is a good thing :). ~eureka
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1475202_tn?1388955435
That's really great that they have the ability to measure PH. Although it seems the procedure would be invasive in which case I agree it's not necessary. Thank you for posting the article Mike.

Randy
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Avatar_n_tn
Rpoo was our spleen always enlarged, meaning the very first ultrasound upon diagnosis? I think you said you had the varicose upon diagnosis yes?
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Avatar_n_tn
This is interesting. My Uncle who has a fatty liver and does not drink and is very healthy has an an almost identical ultrasound to your :)
I asked my cousin who works at a hospital, and he said that if the "prior findings" on your report didn't state "Cirrhosis" in the top left (in other words, had the doctor simply ordered a routine ultrasound for you without tipping them off of cirrhosis" your report would have read "heterogenous echo texture consistent with fatty infiltration of the liver"

Course and nodular echotecture consistent with cirrhotic changes" would be confirmation of Cirrhosis. Of corse we know one can have cirrhosis and it mimic fatty liver in early stages, the nodular changes come latter, BUT I don't understand how you can have varices if the doppler ultrasound did not show any indication of portal hypertension via dilation of the portal tree, nor did it show any other vascular abnormalities.

My doctor told me once, that the size of the spleen actually changes all the time, when you get the flu it will enlarge. although your low platelets are concerning.
Im just thinking, that IF you do indeed have Cirrhosis perhaps its at an earlier stage then they think.
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Avatar_n_tn
This gives the best explanation in my opinion:
http://www.efsumb.org/ecb/ecb-ch02-ultrasoundliver.pdf
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1475202_tn?1388955435
Jon you make a good point so I was looking through my medical records and found my earliest ultrasound from march 16, 2010.

As these results show mild splenomegaly was diagnosed with a measurement of 14.63 cm in length x 14.81 in width. This was a ultrasound of the abdomen area with Doppler with a history of high LFT's noted.

Heterogeneous echotexture throughout the liver with marked nodularity of its contour.

It would seem such a specific diagnosis can’t be made while the liver is still inflamed and irritated from alcohol abuse but you must keep in mind the diagnosis has to be made at some point and everything ingested will cause the liver to react. The liver effects so many systems in the body that there are just to many variables to know what would be an appropriate healing time to make a more specific diagnosis and every case is different.

On 04-15-10 was my first endoscopy showing results of grade 3 varices in the middle third and lower regions of the esophagus. Also at the gastro esophageal junction were the largest in diameter. The pictures still gross me out.

04-16-10 was my CT scan results indicate a mild amount of ascites present. Cirrhosis is once again confirmed along with ultrasound diagnosis.

Since then no ascites have been present. My spleen has increased but only in length by 3.5cm over the past year. This is the result of portal hypertension and decreased platelet count.  As of October 2011 I have a MELD score of 11. Back close to the time of diagnosis I believe my MELD was 17.  At one point my doctor has stated my liver to be compensated and decompensated. Again so many variables as he explained.

To date as close as possible:
01-18-12
creatine- 0.6
bilirubin- 2.3
AST- 43
monocytes-14
platelet count- 71
ammonia- 51
This is based on a CBC and CMP panels in addition to ammonia and AFP tumor marker- 3.7 normal.

Doc still says transplant but I still keep positive with continuous lifestyle changes to prove otherwise. Time will tell.

Randy
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