Coughing up blood sounds like lung/esophagus issues. Heavy drinking can cause esophageal cancer...has he been checked for that?
I would say an Endoscopy is in order.
"Coughing up blood" is rather vague.
I have coughed so hard that I saw a little blood in my spit. In that case perhaps you could say that inflammation caused one to cough up blood.
But, but that's vastly different from vomiting blood. I have done that too and, for me, it was several units of blood that came up. Vomiting blood in an HCV positive patient strongly suggests ruptured esophageal varices.
I agree with Boobert - if he is vomiting blood he should undergo endoscopy and sooner rather than later.
“My question is can inflammation alone cause one to cough up blood or is his liver in far worse shape than he thinks?”
Esophageal varices that rupture and bleed (that are associated with HCV) are a result of increased portal tract pressure, and develop as a result of severe scarring/cirrhosis of the liver.
“I know without a BX there is no way of knowing the extent of damage but just how much damage will an ultrasound show?”
An ultrasound can size organs like the spleen and liver that are often enlarged as a result of cirrhosis. It can also check diameter of the portal vein, ascertain the flow through the portal tract. If frank cirrhosis is present, there’s a pretty good chance an ultrasound scan would pick it up. If a person is stage F3-4 or transitional to cirrhosis, maybe not so well.
Also, routine labs like a CBC and comprehensive metabolic panel check for changes in platelets, protein synthesis, coagulopathy etc; it’s quite possible to diagnose established cirrhosis without biopsy, Ricky.
Good luck to your bud; like you say, he’s heard what he wants to hear for now. Hopefully, something will come along to change his mind before it’s too late. Maybe he’s got an ulcer or something not to onerous right now, and this will be enough to change the way he perceives life?
Hey Ricky....If he is actually coughing the blood it would seem a good doc right away would want to do a chest x-ray to rule out a lung issue also .
Ricky, if he wanted he might consider a fibrosure blood test. They are often considered to be about 85% the accuracy of a biopsy. they are CHEAP and fast and with fast results.
If it were to turn out that a Fibrosure indicated damage in would be one more means of persuasion to get further doctoring. At this point I would imagine that part of the issue is that your friend doesn't want to spend money, will only devote minimal effort to find out what the issue is. As good as some of the evaluation tools may be if he will not avail himself to them they are useless.
The fibrosure may be an easy way to get some light, cheap and fast testing. The results may serve to get him in the door to a specialist/ clinic for some higher level doctoring. When I got my test it was about $325; something like 35 bucks with insurance.
I wanted one, had to tell the doctor what to order, checked with his medical lab and had them call and tell him what he wanted to order. : )
I had the results in a few days; Stage one verified by a biopsy several years later; stage 1/6 ishak.
Willy-I really don’t think he wants to know.
According to his ex-roommate it was quite a bit of blood. I didn’t think about Ulcers or lung/esophagus. I was assuming it was the HCV since he drinks so much.
It’s a hard to watch someone you’ve known for years, self destruct. He was always a heavy drinker but he has become a drunk. I’ve tried to talk to him when he was sober and explain, regardless of what his Dr. told him, he is going to die a horrible death if he continues. His response was he is ready to die anyway. My response was, if you’re ready to check out, then check out but there is a hell of a lot better ways to do it than this. He got quiet then changed the subject so maybe I struck a nerve. I’m going to step back for a little while before talking to him again. After reading some of these posts , I’m starting to wander if he has other health issues, he’s not talking about. This would explain his attitude.
I wouldn't worry about a fibro anything until he finds out WHY he is bleeding in the first place. I mean isn't that the issue? If he doesn't care about that part he certainly isn't going to care if he has mild/moderate/severe liver damage at all.........
What I mean is he is not bleeding from his liver - find out what it is is the only thing that makes sense all else is just guessing.
That is one reason i thought that the simple blood test might slide by but something like a biopsy wouldn't. I'm pretty sure that he doesn't want to know.
LOL; I don't want to get tests either. No new is good news; right?
“all else is just guessing”
I should have asked my question better. Even though it is speculation, The guy drinks Jagermiester and has HCV so, I would assume his liver is inflamed. Could an inflamed liver constrict blood flow forcing pressure on blood vessels causing them to burst? I know this is mere speculation (I’m not trying to be House) but is it possible?
Never had an esophageal bleed but once those vessels burst it entails a lot more than just coughing up blood. As a rule those blood vessels just don't seal themselves back up and bleeding out can happen quickly.
Did you see Jeff Bridges in Crazy Heart? He was a bad alcoholic and towards the end the old boy was dying from the booze, p-issing himself, coughing up blood and on his way out. That was a pretty fair depiction of a raging alcoholic. If there is any reasoning left in your friend and he cares at all his first priority should be to start detoxing and then see what kind of damage has been done. All the tests in the world aren't going mean a damn thing if he doesn't give up the booze. If he chooses not to do anything soon it won't matter anyway.
Google "esophageal varices".
With cirrhosis the liver becomes less porous and the flow through the portal vein gets restricted. This is "portal hypertension". The blood which ordinarily flows through the portal vein meet resistance and therefore seeks a path of lesser resistance. This can result in vessels in the esophagus becoming distended - imagine hemorrhoids in the esophagus. If they rupture they bleed = ruptured esophageal varices.
Cirrhosis isn't exclusive to HCV. It can result from any serious liver disorder... including alcoholism.
It is not liver "inflammation" Rick. It's "cirrhosis" that results in variceal bleeding - bursting vessels, if you will.
I saw an episode of ER where an alcoholic was bleeding out and going into withdrawl. He opted to not get treated, didn't want dialysis for the rest of his life. They mainlined some type of "something" through his IV. He died peacefully bleeding out.
I know it was just a show but ........ that thought crossed my mind quite a few times for the drunks that don't quit when they should.
That pretty much rules my theory out. I was thinking it would be more like a “Bloody Nose” except in the esophagus.
I know you can’t help someone that doesn’t want to help themselves. Like you said, “it soon won’t matter anyway.”
Thanks, I will look it up when I get home.
Wow Rick. I'm really sorry about your friend. It must be really hard for you to deal with this. I just hope that he will be willing to open up and listen to you soon.
"Willy-I really don’t think he wants to know"
R glass - that says it in a nut shell. Almost no one knew I treated for Hep C. However, I told one woman I suspected had cirrhosis hoping she would confide in me and maybe get help. I don't even know if she has Hep C - it is probably alcoholic cirrhosis. She just shrugged it off and said she doesn't go to the doctor. Now, three years later, she is dying. Hospice has been called in. She is coughing up blood, and maybe more like vomitting blood. The GI her kids finally took her to just sent her home and said there was nothing to be done. Her two children, 24 and 28 are standing 24 hour per day vigil. It is just a matter of time. You can't help someone who is in denial. As much as you want your friend to see the light, it really is up to him.