Portal Hypertention

One year ago I took my last drink after I was diagnosed with alcoholic cirrhosis stage C.  My blood tests showed the following areas were out of range and high: glucose, globulin, bilirubin, alkaline phosphate, AST and RDW.  The areas that were low were: creatin, albumin, A/G ratio, red cell count, hemoglobin, hematocrit, platelets and lmphocytes.  I have a hiatial and umbilical hernia, grade III varicies and have developed hepatic encephalopathy due to damage from too much alcohol, mixed with high levels of ammonia.  My recent ultrasound, just 10 months after the first, shows I have moderate spleenomegaly with a size of 17.99cm x 16.95cm.  My varicies are still grade III.  I have no edema or ascites.
Three months after the 1st blood result, I showed great improvement.  All tests were back in range with the exception of having high bilirubin (2.1), ammonia (60), and a low platelet count (88).  Now that a year has passed the only blood results I'm dealing with is a continuation of high ammonia, bilirubin and low platelet count.  My RDW has since increased as well.
You would think my liver has greatly improved.  I do exactly as my doctor says.  However, due to portal hypertension my varices are bad and my spleen is twice the normal size.  I also hear the ammonia can come from portal hypertension (p.h.) causing my blood to bypass my liver.
So is it normal for a patient to have cirrhosis with a well functioning liver in some ways, but still be affected with this blood flow problem?  I have hopes that my liver is getting better.  With my issues from portal hypertension, it makes me think otherwise.  I'd also like to know what it would take to reduce my p.h. or help my spleen from getting any larger.  I was already treating my high blood pressure with a beta blocker which my doctor says will also help with the p.h.  My blood pressure on average has been 100/55 for quite some time - even before my diagnosis.

[Thomas D Schiano, MD]

with further time hopefully the portal hypertension will also lessen or resolve.  Alcohol-related cirrhosis is well known to cause portal hypertension in the setting of well preserved liver function, in large part due to the location of the scarring in the liver.  remember also that even the liver numbers have improved you are still at risk for developing HCC, so you should have the appropriate surveillance.

[rpooo]

What is HCC and why am I at risk for it? Am I right in assuming it's liver cancer? Why will the Portal Hypertension lessen or dissolve? Is that due to the liver breaking down further or because of the ability for it to regenerate. This will depend on the scaring I also assume so can that be determined with an ultrasound. I guess what I’m trying to determine now that I have a much better understanding of cirrhosis is how far did I really damage my liver. I understand the liver can only handle so much damage before it is to the point of no return. Could that be what the diagnoses beginning of end stage (C) means? See if I didn't have this portal hypertension I believe everything else would return to normal. I just need to get this liver to work quicker or slow down the blood flow. Maybe I should just wait for further recovery and everything fixes itself. I don’t know, what would you do?
Thank you Doctor.

Randy

[Thomas D Schiano, MD]

HCC is primary liver cancer, which cirrhosis predisposes to.  the portal hypertension will lessen and hopefully resolves over time but the sdcarring in the liver takes a much time to regress and that is what places the individual at risk.  I do not think that you reached the point of no return so keep doing what you're doing.