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4705307 tn?1447973922

Fibrosis

Yes this late is in the game, 37th week of tx, and yet I have seen it so much I can't help but ask. Why hadn't my Dr.s done a biopsy. When I asked him during our last appointment he referred to my my ultra sound and referenced my enlarged liver and spline. Saying I have fibrosis. I have looked and looked trying to decipher it, I see nothing that refers to fibrosis what stage or anything else. Can anybody come up with a good reason not to do a biopsy? Is there enough information in an ultra sound and blood work to make decisions when or if to treat. There seem to be issues regarding my health that have been moved aside until I complete tx    
22 Responses
Avatar universal
One of the reasons people with HCV undergo liver biopsy is to ascertain the condition of their liver to help in making the decision whether or not to treat. You're already treating so in that context there is no need for or value in a biopsy.
Of course, we all want to know the condition of our liver but in your situation I don't know that a biopsy would be very useful. Although the risks are low for biopsy associated complications there is nevertheless some degree of risk. I don't know your platelet count or clotting time but it's not unusual during interferon treatment to have a decreased platelet count so the risk to you may be slightly increased since you're undergoing interferon treatment.
And, hopefully you will achieve SVR and again, hopefully, your liver histology will improve with some time. I am suggesting that the snap-shot a biopsy at this time would give you of your liver might not be illustrative of your liver condition once you achieved SVR and lived virus free for a while.
I just don't see the importance for a liver biopsy at this time. We could argue about the advisability of one before you decided to treat but that's another discussion.

Good luck,
Mike
Avatar universal
            hey timothy,  i have seen a shift by my HMO in their use of liver bx. my hmo uses needle biopsy only.  and because of the invasive nature of the procedure, they only use it for diagnostic purposes, and to check the rate of progression.        barry
5720485 tn?1373566655
You can get Fibroscan now, non invasive.   If you want to know the condition of your Liver, just so you know.  It's 94% accurate.
Shyrl

Avatar universal
  I dont believe we use FibroScan yet, in the U.S., my Dr said the machine is rly expensive.
  An ultrasound is mostly only useful for seeing masses in the liver, or nodules on the edge, and it can measure the size.
   After you get finished with yr Tx you can go and have a biopsy, but not while on yr Tx, when the platelets are low, etc
   I had a test called a FibroSure, which consisted of alot of labs analyzed, and the resultant score of these labs had me as Cirrhotic. So I went and had a liver biopsy, and it had me as a stage 2. It was a good idea for me to know that, because cirrhotics have to treat for 48 weeks.
   Did you have any of the usual signs of cirrhosis, before yr Tx? These would be platelets lower than 80, and edema (think bloated legs, socks hurting and making a mark, legs look full of fluid, cuz they are) or ascites, think: pregnant looking belly, protruding high up, and out, feeling hard...a fetid odor to your breath, like rotten fruit...also Encephe....a rly bad memory at times, from ammonia on the brain-
  
1654058 tn?1407162666
Good advice from all the resident experts. It would have been nice to have for reference or as a baseline. They must not have thought you had severe cirrhosis, or they would have probably referred you to a transplant center for treatment.
I'm happy to hear that you are almost finished! Congratulations! I'll bet you're ready..
xo Karen:)
Avatar universal
Hepatic Encephalopathy..the brain memory symptom of cirrhosis...hurrrr, I can never spell that one, thus it's initials: HE
  And we cant forget varices, which can present as a rupture of the vein in the esophagus (for example) which causes vomiting a large amount of blood, or varicosities in other regions, one is on the stomach, and looks like Medusa~
   There are also a few other labs that will be off, with cirrhosis, like high bilirubin, which causes itching (I had that one without the cirrhosis though, but again, a mild bili elevation, cuz I wasn't cirrhotic) etc.
   The Gold Standard here in the U.S. is still a biopsy, I I like them, cuz we get to look at our liver tissue :)
   You could wait until a year after your Tx, so you could also see the improvement~
Avatar universal
The degree of cirrhosis Bo is referring to is late stage and ESLD.

You can have cirrhosis with little to no symptoms.



Avatar universal
  Yes, you can have cirrhosis without those symptoms, or be a stage 3 and have some of those symptoms, but mildly. Like my socks used to make this huge indentation in my ankles, until I SVRed.
   But a cirrhotic liver is smaller then average,(shrunken and hard from being taken over by scar tissue)) and a swollen liver means that it is inflamed, which can lead to scarring~ I notice that Kaiser Dr's arent big on ordering biopsies, so maybe it's the cost :(    They didn't give my friend one, knowing he had the virus for over 40 yrs, so when he finally insisted, he had cirrhosis
Avatar universal
Wait until you are done TX then if you are still curious about fibrosis stage have a biopsy done. I would want to know especially if a doctor told me I had fibrosis.
Keep in mind TX can sometimes help the liver regenerate so hopefully that is what happen in your case.

By the way the fibroScan is NOT 94% accurate. Actually no better then the  fibrosis blood test. Some what accurate for low & high end of fibrosis (F1 & F4). Not that accurate for middle stages (F2 & F3)
Avatar universal
  Also, a Biopsy can be off by 1 stage, either way.  I just pieced all my info together:  My labs had my platelets low (and I was bleeding ALOT when I flossed), and my AST and ALT elevated ten fold. My FibroSure test had me as cirrhotic, my biopsy had me at a stage 2, grade 3(the grade shows inflammation, the stage shows amount of scarring), and I had begun to have many new symptoms all at once:  a varicose vein in my left calf, spider veins appeared out of nowhere,  and when I took tylenol, Ibuprofen, or certain herbs(it was chapparral) I got rly painful muscle cramps.
   I put all the info together, and checked my labs after my Tx, and things were back to normal. I decided I am probably a stage 3.
  
1815939 tn?1377995399
"But a cirrhotic liver is smaller then average,(shrunken and hard from being taken over by scar tissue)) and a swollen liver means that it is inflamed, which can lead to scarring~"
------------------------------------------------------------

"Some patients with cirrhosis have enlarged livers and/or spleens. A doctor can often feel (palpate) the lower edge of an enlarged liver below the right rib cage and feel the tip of the enlarged spleen below the left rib cage. A cirrhotic liver also feels firmer and more irregular than a normal liver.  .....
Computerized tomography (CT or CAT) or magnetic resonance imaging (MRI) scans and ultrasound examinations of the abdomen done for reasons other than evaluating the possibility of liver disease may unexpectedly detect enlarged livers, abnormally nodular livers, enlarged spleens, and fluid in the abdomen that suggest cirrhosis."

http://www.medicinenet.com/cirrhosis/page4.htm


"Cirrhosis may be associated with a liver of small, normal, or enlarged size. .....  In cirrhosis, the liver may be enlarged or small, the latter usually occurring in end-stage cirrhosis or fulminant hepatic failure following hepatocyte necrosis and collapse. The consistency is usually nodular in cirrhosis. Classically it is micronodular due to alcoholic or nutritional disease and macronodular when cirrhosis is posthepatitic."

http://www.ncbi.nlm.nih.gov/books/NBK421/


http://emedicine.medscape.com/article/366426-overview
Avatar universal
Thank you.
Avatar universal
http://umm.edu/health/medical/reports/articles/cirrhosis

Chronic Viral Hepatitis
Chronic viral hepatitis, both hepatitis B and hepatitis C, is another primary cause of cirrhosis. Chronic hepatitis C is a more common cause of cirrhosis in developed countries, while hepatitis B is a more common cause of cirrhosis worldwide, especially in sub-Saharan Africa and parts of Asia. People with chronic hepatitis B who are co-infected with hepatitis D are especially at risk for cirrhosis. The longer a patient has had chronic hepatitis, the greater the risk for eventually developing cirrhosis.
Hepatitis viruses can produce inflammation in liver cells, causing injury or destruction. If the condition is severe enough, the cell damage becomes progressive, leading to scar tissue in the liver. In advanced cases, the liver shrivels in size, a condition called postnecrotic or posthepatic cirrhosis.


Source: Cirrhosis | University of Maryland Medical Center http://umm.edu/health/medical/reports/articles/cirrhosis#ixzz2bpANc0dX
University of Maryland Medical Center
Follow us: @UMMC on Twitter | MedCenter on Facebook
1815939 tn?1377995399
" In advanced cases, the liver shrivels in size, a condition called postnecrotic or posthepatic cirrhosis. "
---------------------------------------------

There is a huge difference between this statement in your original post, "But a cirrhotic liver is smaller then average,(shrunken and hard from being taken over by scar tissue))"          and this statement in your most recent post.... "In advanced cases, the liver shrivels in size, a condition called postnecrotic or posthepatic cirrhosis."

Not all cases of Cirrhosis are advanced. In fact. most cases of Cirrhosis are not advanced. It is important to know the difference.
Avatar universal
"Not all cases of Cirrhosis are advanced. In fact. most cases of Cirrhosis are not advanced. It is important to know the difference."

I agree with this statement 100%... A HUGE difference in "early cirrhosis" and "ESLD".......
Avatar universal
Thanks for clearing that 94% up.

Mike
Avatar universal
Yes this late is in the game, 37th week of tx, and yet I have seen it so much I can't help but ask. Why hadn't my Dr.s done a biopsy.
-------------------------------------
Possibly because many knowlegable physicians see no need to engage in this invasive procedure if the desician has already been made to do therapy.

It is redundant and as mikesimon has pointed out above

"You're already treating so in that context there is no need for or value in a biopsy.

Good luck

Will

4705307 tn?1447973922
That is what happened,"Possibly because many knowlegable physicians see no need to engage in this invasive procedure if the decision has already been made to do therapy." Based  on my state of health at the time the decision to treat was made, he told me, " Hopefully some if not all of these other underlying problems will resolve themselves." He also said there was no reason go with a biopsy stating the invasiveness of the procedure, and the possible problems associated with it. Bleeding, more pain, cost etc..
Following my chemical physicals at all accounts I am doing really well,better than most. And yet if I had to say it I "feel" sicker than most.
My visits with my Hep C Dr. have become much like a social call, wherein we discuss my platelets staying in the normal range, my ANC is holding etc. All things are on track for completion at 48 weeks.When I do refer to whats going on he basically tells me we need to wait and see.
In one of our visits to an urgent care, the Dr. outlined the lower periphery of my liver, where it actually extended two inches below what would be normal. I really paid little concern of that, I have seen how swollen people become because of their liver, not a pretty sight. As of late I have developed a pain on my left side lower rib cage that feels as if I have been kicked by a full grown horse, my thoughts are to make a call to my PCP and go see her, and yet part of me knows it is just the nature of the beast, tx.
As always I thank everybody for their knowledge and insight fulness, I wish I could give each and everyone a star.        
Sincerely      
Tim
Avatar universal
http://www.mayoclinic.com/health/enlarged-spleen/DS00871

Definition
By Mayo Clinic staff
Image of enlarged spleen
Enlarged spleen
Your spleen is an organ located just below your rib cage on your left side. A number of conditions — from infections to liver disease and some cancers — can cause an enlarged spleen, also known as splenomegaly (spleh-no-MEG-uh-lee).

Most people don't have symptoms with an enlarged spleen. The problem is often discovered during a routine physical exam. Your doctor can't feel a normal-sized spleen in adults — unless you're very slender — but can feel an enlarged spleen. If you have an enlarged spleen, your doctor will likely request imaging and blood tests to help identify the cause.

Treatment for an enlarged spleen focuses on relieving the underlying condition. Surgically removing an enlarged spleen isn't usually the first treatment, but it may be recommended in certain situations.

   Tim, it is always worth it to mention any new symptom to your Doctor(s), while you are in Treatment.  I only went to my PCP with a sx once, while I was on my Tx, becuz my Tx Doc was out of town.
   My PCP and Tx Doc hadn't been in contact with each-other, so they weren't working on me as a Team.  IMany PCP's know little to nothing about Hep C, which shocked me. I went for a rash, and my PCP told me I was "allergic to one of the three meds I was taking, and I would have to find out which one, and discontinue it"  I was like, "whattt?" I couldn't believe she hadn't even heard about "Riba Rash"!  I had just come to her, for a prescription for hydroxyzine (anti-itch pills)
   I have also heard other first-hand accounts of people going to the E.R. with sx complaints, and when the ER Doc saw how low their HGB was,(from their Incivek use) they were discontinued from Tx...where-as, a Tx Doc would have known that low HGB is expected, during Tx.
    That is why it is best to let your Treating Doctor know, and also your PCP.  He can order an extra blood test,  or have you order on via your PCP, to determine what is causing this new pain.
317787 tn?1473362051
Timothy, I agree with Bo, every change should be reported to your doctor.  I know you have a tendency to not "bother" your doctor but that is what he is there for.
Does your doctor have a representative you can talk to?  Usually a nurse or an assistant that you can call when you are having problems?

Everyone above has given you great advice.  When I found out I had HCV the doctor told me that I had plenty of time to tx.  Then he did the biopsy and we found that my blood work did not indicate how badly my liver was damaged and so I had to start tx.  To me the biopsy indicates if you need to tx right away or can  you wait.

In your case you are already on tx.  Right now would not be the best time for a bx.

Hang in there Tim you are so close to finishing, I wish you the best.
Dee
5720485 tn?1373566655
Correction, Regarding Fibroscan, 94% accurate, should say;  up to 94%
Mixed results in this study, more accurate with lcirrhosis.  My Doc in Canada recommended, while on TX. . . Just saying.  Widely used now in Canada, on
Y 125.00. Not tooting any horns, just saying its available, if you don't want to undergho biopsy.  

http://www.ncbi.nlm.nih.gov/pubmed/19581812
5720485 tn?1373566655
And yes I hear from many on this forum that many are not sold on the accuracy of FibroScan, I had one, it truely is non-invasive, only takes 10 minutes, and  not expensive here anyway,  only $125.00 can.  So my fingers are crossed that my scan was fairly accurate, In my case I probably won't have a biopsy unless there a need comes up.  But I can only say what I did, not recommending at all.  

Thanks all, and thanks for keeping me on my toes.  
Lol Fibroscan Co says 94% accurate of course.
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