help with biopsy results

[acv032408]

  Hello.  I would like to start this question by stating that I know a lot of us reading these posts are patients and not doctors.  I do, however know that a lot of patients are extremely knowledgable and can offer some help to me.  
  Two weeks ago, I had a liver biopsy.  I recently received the results and even after talking to the doctor am still confused.  The results are as follows:
   Steatohepatits (activity level 4) with pericentral fibrosis and occasional bridging (fibrosis score 2-3).
   Trichrome stain confirmatory.

   I was diagnosed with compensated cirrhossis a year ago and this biopsy was to help determine the severity of my liver.  What is activity score 4?  Is pericentral fibrosis and occasional bridging very bad?  Does this mean it is confirmed that I hve Cirrhosis?  Thank you in advance for your responce.  Tom

[jonkob]

Hate to be a pain, but if you posted your blood test results you may get more input.
specifically
ALT
AST
Bilirubin
PPT
Platelets
albumin

Also, what do you mean "lesions" ?

[acv032408]

My blood results show moderately elevated liver enzymes.  Ultrasound shows lesions, liver swollen and an enlarged spleen.  I have had one doctor tell me that I have NASH and one tell me that I have compensated cirrhosis.  I am just trying to get some insight as to how bad or good things are with my liver.  Thanks for your response.

[jonkob]

what are you bloods like? Ultrasound etc?
Im just curious why they did the biopsy in the first place.
There seems to be some question over the diagnosis

[acv032408]

Sorry, I am not a drinker.  Stupid autocorrect.

[acv032408]

Thank you for the great info.  I guess I should have noted that I am not a dinner and prior to the compensated cirrhosis diagnosis, I was diagnosed as having NASH.  So, is there a difference between NASH and compensated cirrhosis?  Again, thank you for all the great information.

[mikesimon]

What is activity score 4?

I do not believe that this is what we normally think of when we see a liver biopsy. This number 4 refers to your NAFDL Activity Score or NAS. It is the sum of grade of steatosis + grade of lobular inflammation + grade of ballooning.

"..... Histological features were graded according to the NAFLD scoring system proposed by the National Institute of Diabetes and Digestive and Kidney Diseases NASH Clinical Research Network.[23] Briefly, grade of steatosis was scored as 0 = 33–66%; 3 = >66%; grade of lobular inflammation was scored as 0 = no foci; 1 = 4 foci/200×field; and grade of ballooning was scored as 0 = none; 1 = few ballooning cells; 2 = many cells/prominent ballooning. The grade of steatosis (0–3), lobular inflammation (0–3) and ballooning (0–2) were then combined to determine the NAFLD activity score (0–8) as proposed. ..."

http://www.medscape.com/viewarticle/761457_2


The NAFLD Activity Score (NAS) score can be from 0 to 8.  Yours is 4.

"Total NAS score represents the sum of scores for steatosis, lobular inflammation, and ballooning, and ranges from 0-8. Diagnosis of NASH (or, alternatively, fatty liver not diagnostic of NASH) should be made first, then NAS is used to grade activity. In the reference study, NAS scores of 0-2 occurred in cases largely considered not diagnostic of NASH, scores of 3-4 were evenly divided among those considered not diagnostic, borderline, or positive for NASH. Scores of 5-8 occurred in cases that were largely considered diagnostic of NASH."

http://tinyurl.com/bx7hdcv

Steatohepatitis seems consistent.

[HectorSF]

'I was diagnosed with compensated cirrhossis a year ago and this biopsy was to help determine the severity of my liver. '
- You do NOT have cirrhosis.
A fibrosis score of 2-3 means you are starting to have signs of stage 3 liver disease. (bridging).

What is activity score 4?
- A very high level of inflammation.

Pericentral fibrosis
- fibrosis occurring around the central veins in the hepatic lobules.
- pericentral injury is a hallmark of alcoholic hepatitis; the development of pericentral fibrosis (also known as sclerosing hyaline necrosis or perivenular fibrosis) is an early marker of likely progression to panlobular cirrhosis

Steatohepatits (activity level 4) with pericentral fibrosis and occasional bridging (fibrosis score 2-3).

- Do you mean steatosis???
Steatosis, fatty liver can be a temporary or long-term condition, which is not harmful itself, but may indicate some other type of problem. Left untreated, it can contribute to other illnesses. It is usually reversible once the cause of the problem is diagnosed and corrected. The liver is the organ responsible for changing fats eaten in the diet to types of fat that can be stored and used by the body. Triglycerides are one of the forms of fat stored by the body and used for energy and new cell formation. The break down of fats in the liver can be disrupted by alcoholism, malnutrition, pregnancy, or poisoning. In fatty liver, large droplets of fat, containing mostly triglycerides, collect within cells of the liver. The condition is generally not painful and may go unnoticed for a long period of time. In severe cases, the liver can increase to over three times its normal size and may be painful and tender.

The most common cause of fatty liver in the United States is alcoholism. In alcoholic fatty liver, over consumption of alcohol changes the way that the liver breaks down and stores fats. Often, people with chronic alcoholism also suffer from malnutrition by eating irregularly and not consuming a balanced diet.

Fatty liver is usually reversible if recognized and treated.

Get help from a hepatologist soon before you develop cirrhosis.
You must stop drinking alcohol completely if you are.

Hector