cryptogenic liver disease ESLD

Dear Dr. I have been on the waiting list for 2 and a half years at Scottsdale Mayo. I still do not understand this whole situation would you please read part of my biopsy and try to enlighten me. I am currently only taking lactulose for my occational encepalopathy. Have only been hospitalized the first time with extremely high ammonia levels . Now I only go to the DR. so they can look at me and do labs. All which could be done at my local hospital. Mayo 600 miles away.

inflammatory activity consistent with grade 2 of 4 and a focal nodular proliferation of bile ducts consistant with an incidental bile duct harmatoma. The iron stain shows no evidence of hepatocellular iron deposition . The hepatocytes show focal ballooning degeneration. The  trichrome stain shows bridging fibrosis with changes consistent with cirrhosis stage 4 of 4.

Final Pathologic Diagnosis
Cirrhosis with mild inflammatory activity...histolic findings are nonspecific but posible etiologies which should be ruled out include chronic viral hepatitis autoimmune hepatitis primary billary cirrhosis diabetis and wilsons disease .  Iron stain negl ruling out possble hemochromatosis .i
I understand the words , I just don't understand That unless I have all symptoms. Which I fortunatly do not have. I must have a complete liver shut down. They tell me I am doing fine but could turn around within 48 hours.  I could just go on and on . I never  drank. Did not take drugs. Except for my BP. meds. I did take a great deal of tylenol due to my osteoarthritis, osteoperosis , bulging disks ect.I did have hep A when I was little  now they don't want me to take much of anything. I am allergic to most other pain meds, so besides looking fine I have had a very painful 3 years. ,

[Thomas D Schiano, MD]

the liver biopsy findings are consistent with cirrhosis, cryptogenic in nature.   There seems to be nothing potentially treatable on the biopsy and one's prognosis is primarily based on blood tests assessing the liver's synthetic function.  You might want to have the liver biopsy slides sent for another opinion.  an experienced liver pathologist at our center is dr M. I. fiel.