Aa
varices
How quickly can someone with hep-c go from no varices to varices? Are varices an indicator as to the stage of cirrhosis?
" If I have no varices or portal hypertension how can they even be sure I have cirrhosis w/o a biopsy and how much time considering my age do I have to wait before I get into serious trouble with varices and portal hypertension?"
As we said varices are a product of cirrhosis + portal hypertension. No cirrhosis with portal hypertension = no varices. (Folks with early cirrhosis can have no portal hypertension, thus no varices). That is how is works.
A person with cirrhosis and portal hypertension is every for any hepatologist or good gastroenterologist to detect starting with a physical exam. Cirrhosis and portal hypertension has many signs that can be recognized by a experienced and skilled doctor. Cirrhosis can also be seen on any imaging studies that have been performed such as an ultrasound.
Once diagnosed with cirrhosis there is no reason to perform future biopsies unless the cause of the cirrhosis has been stopped and there is the possibility off the cirrhosis instead of its usual progressive to a more decompensated state.
Detecting early cirrhosis is more difficult and my require a biopsy as it may have few effects on the body other than the liver.
How much time do any of us have before our cirrhosis becomes irreversible? There no timetable. Everyone is different. For one person it could be 6 months another 10 years. It is the job of your liver specialist to monitor for progression of your liver disease.
The only way to know for sure what stage of liver disease anyone has is to get a biopsy or transient elastography such as Fibroscan and have a good liver doctor who is works with those with all stages of liver disease including cirrhotics.
Best to know if you have cirrhosis as SRV rates are very different for cirrhotics compared to others using any treatment. For example
Ledipasvir/Sovaldi Treatment
Genotype 1a
No Cirrhosis - 95% SVR
Cirrhotics - 86% SVR
Cheers!
Hector
As we said varices are a product of cirrhosis + portal hypertension. No cirrhosis with portal hypertension = no varices. (Folks with early cirrhosis can have no portal hypertension, thus no varices). That is how is works.
A person with cirrhosis and portal hypertension is every for any hepatologist or good gastroenterologist to detect starting with a physical exam. Cirrhosis and portal hypertension has many signs that can be recognized by a experienced and skilled doctor. Cirrhosis can also be seen on any imaging studies that have been performed such as an ultrasound.
Once diagnosed with cirrhosis there is no reason to perform future biopsies unless the cause of the cirrhosis has been stopped and there is the possibility off the cirrhosis instead of its usual progressive to a more decompensated state.
Detecting early cirrhosis is more difficult and my require a biopsy as it may have few effects on the body other than the liver.
How much time do any of us have before our cirrhosis becomes irreversible? There no timetable. Everyone is different. For one person it could be 6 months another 10 years. It is the job of your liver specialist to monitor for progression of your liver disease.
The only way to know for sure what stage of liver disease anyone has is to get a biopsy or transient elastography such as Fibroscan and have a good liver doctor who is works with those with all stages of liver disease including cirrhotics.
Best to know if you have cirrhosis as SRV rates are very different for cirrhotics compared to others using any treatment. For example
Ledipasvir/Sovaldi Treatment
Genotype 1a
No Cirrhosis - 95% SVR
Cirrhotics - 86% SVR
Cheers!
Hector
Ive had hep-c approximately 50 years. 1a. 2 biopsies. the one in 2010 they thought was still stage 1 but the sample was not sufficient to be sure. I recently had an ultrasound along with a colonoscopy. I had no varices nor portal hypertension, although I have gastritis with some Barretts esophagus. The ultrasound showed normal spleen (although my platelets are low around 110. ) The ultra showed what they said was "suggestive" of cirrhosis. Im 68 years old and recently failed olysio/sovaldi tx. Almost negative at 2 weeks, (57 was the number. Tx was stopped at week 8 because the test, (a yes or no, positive or neg only test) showed still positive. They stopped tx . I went an extra week to 9 weeks tx before they said stop tx. My question is: If I have no varices or portal hypertension how can they even be sure I have cirrhosis w/o a biopsy and how much time considering my age do I have to wait before I get into serious trouble with varices and portal hypertension? A guess would be fine. I am going to ask for a biopsy next time before I re-treat. Im getting excess reflux and burning from the stress. The diet isn't causing it. Can I afford to wait a while until the new treatments become more established before tackling this tough bug Ive got.
My Hepatologist said you must have cirrhosis and portal hypertension to have varices. Some get them when they are just bridging over to cirrhosis and others dont.I know some patients that have cirrohosis for over 10 years and have no varices, everyone is different. The norm is that It takes approx. ten years to go from compensated cirrhosis to decompensated cirrhosis and that was told to me by a tranplant doc at the Hospital.
Let me address these issues logically.
"Are varices an indicator as to the stage of cirrhosis?"
Varices are a complication of cirrhosis + portal hypertension. So a person must have BOTH to be at risk of developing varies. For those with lesser stages of liver disease varices is not an issue.
All hepatologists and educated gastroenterologists who care for cirrhotic patients monitor the person's cirrhosis periodically over time. Once a person has developed a certain degree of portal hypertension they are likely to begin to develop varices. The most common location of varices in the esophagus. To monitor these varices or gastric varices (the 2nd most common type of varices) an endoscopy is performed to to determine the grade of any varices. The point being that as the cirrhosis advances its complications can also progress. Varices like the cirrhosis itself develops typically over a period of years.
I should mention that varices like other anatomical changes to the body that occur as the cirrhosis progresses can be "seen" on imaging studies such as an ultrasound.. The enlarged spleen (which causes the resulting low platelet count seen on labs), the dilated portal vein, collateral veins, the paraumbilical vein, the reverse flow in portal vein, any ascites any of these will be noted in the imaging report.
As in all cases of hepatitis C and liver disease, a patient only needs to ask their gastroenterologist or hepatologist if they have varices or any other complication of their diagnosed cirrhosis they may have. Also all of us has a right to access all of our medical information and many of us have done this. A simple HIPPA form completion is all that is required. For those who get copies of their medical records all the information about our hepatitis C and extent our liver disease and any other complications resulting from it is noted in the medical records. Many people have posted parts of their records for others with more experience to help them understand exactly what the document means. We has seen MRI, ulrasound, CT, biopsy and doctor's notes posted numerous times.
How quickly can someone with hep-c go from no varices to varices?
As I said varices are a result of portal hypertension and develop with the portal hypertension. So in a person with cirrhosis varices, along with other complications develop over the years that most people have cirrhosis. Should they be able to stop the cause of their liver disease their liver may be able to heal itself which would result in a reduction of portal hypertension (again over a period of years) or if a person has a liver transplant as soon as the healthy donor liver starts working the blood now goes through the healthy liver instead of around it through the collateral veins commonly known as varices. Liver transplant cures portal hypertension and all of its systematic effects. After our transplant most of us never have to take all of the drugs we did before transplant to manage the complications of our cirrhosis and portal hypertension. The lactulose, diuretics, beta blocker, and whatever we were taking due to our cirrhosis and its complications. Then we begin taking about 40 pills a day to manage the consequences of having had a transplant. But that is another story...
Take care.
Hector
"Are varices an indicator as to the stage of cirrhosis?"
Varices are a complication of cirrhosis + portal hypertension. So a person must have BOTH to be at risk of developing varies. For those with lesser stages of liver disease varices is not an issue.
All hepatologists and educated gastroenterologists who care for cirrhotic patients monitor the person's cirrhosis periodically over time. Once a person has developed a certain degree of portal hypertension they are likely to begin to develop varices. The most common location of varices in the esophagus. To monitor these varices or gastric varices (the 2nd most common type of varices) an endoscopy is performed to to determine the grade of any varices. The point being that as the cirrhosis advances its complications can also progress. Varices like the cirrhosis itself develops typically over a period of years.
I should mention that varices like other anatomical changes to the body that occur as the cirrhosis progresses can be "seen" on imaging studies such as an ultrasound.. The enlarged spleen (which causes the resulting low platelet count seen on labs), the dilated portal vein, collateral veins, the paraumbilical vein, the reverse flow in portal vein, any ascites any of these will be noted in the imaging report.
As in all cases of hepatitis C and liver disease, a patient only needs to ask their gastroenterologist or hepatologist if they have varices or any other complication of their diagnosed cirrhosis they may have. Also all of us has a right to access all of our medical information and many of us have done this. A simple HIPPA form completion is all that is required. For those who get copies of their medical records all the information about our hepatitis C and extent our liver disease and any other complications resulting from it is noted in the medical records. Many people have posted parts of their records for others with more experience to help them understand exactly what the document means. We has seen MRI, ulrasound, CT, biopsy and doctor's notes posted numerous times.
How quickly can someone with hep-c go from no varices to varices?
As I said varices are a result of portal hypertension and develop with the portal hypertension. So in a person with cirrhosis varices, along with other complications develop over the years that most people have cirrhosis. Should they be able to stop the cause of their liver disease their liver may be able to heal itself which would result in a reduction of portal hypertension (again over a period of years) or if a person has a liver transplant as soon as the healthy donor liver starts working the blood now goes through the healthy liver instead of around it through the collateral veins commonly known as varices. Liver transplant cures portal hypertension and all of its systematic effects. After our transplant most of us never have to take all of the drugs we did before transplant to manage the complications of our cirrhosis and portal hypertension. The lactulose, diuretics, beta blocker, and whatever we were taking due to our cirrhosis and its complications. Then we begin taking about 40 pills a day to manage the consequences of having had a transplant. But that is another story...
Take care.
Hector
Bleeding esophageal varicies are a medical emergency. If you see red blood in your stool that is probably from hemorrhoids.
My doctor described varicies as looking like varicose veins in your esophagus. So enlarged, distended, swollen looking veins.
After I was banded my doctor initially checked me at 6 months for the first year but now I am checked annually
Esophageal varicies don't have warning symptoms. I got this from the Mayo Clinic web site
http://www.mayoclinic.org/diseases-conditions/esophageal-varices/basics/symptoms/con-20027505
Symptoms
By Mayo Clinic Staff
Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:
Vomiting blood
Black, tarry or bloody stools
Shock (in severe case)
Causes
By Mayo Clinic Staff
Esophagus
Esophageal varices sometimes form when blood flow to your liver is obstructed, most often by scar tissue in the liver caused by liver disease. The blood flow to your liver begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver. This pressure (portal hypertension) forces the blood to seek alternate pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins can rupture and bleed.
Causes of esophageal varices include:
Severe liver scarring (cirrhosis). A number of liver diseases can result in cirrhosis, such as hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis. Esophageal varices occur in about 40 percent of people who have cirrhosis.
My doctor described varicies as looking like varicose veins in your esophagus. So enlarged, distended, swollen looking veins.
After I was banded my doctor initially checked me at 6 months for the first year but now I am checked annually
Esophageal varicies don't have warning symptoms. I got this from the Mayo Clinic web site
http://www.mayoclinic.org/diseases-conditions/esophageal-varices/basics/symptoms/con-20027505
Symptoms
By Mayo Clinic Staff
Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:
Vomiting blood
Black, tarry or bloody stools
Shock (in severe case)
Causes
By Mayo Clinic Staff
Esophagus
Esophageal varices sometimes form when blood flow to your liver is obstructed, most often by scar tissue in the liver caused by liver disease. The blood flow to your liver begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver. This pressure (portal hypertension) forces the blood to seek alternate pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins can rupture and bleed.
Causes of esophageal varices include:
Severe liver scarring (cirrhosis). A number of liver diseases can result in cirrhosis, such as hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis. Esophageal varices occur in about 40 percent of people who have cirrhosis.
The portal vein can't do it's job to send blood around so little thin weak veins grow like they are trying to find a new outlet. But these veins have bubbles on the end and can burst. Endocopies show when those "bubbled veins" need to be banded. You'll have symptoms of varices before they rupture. Blood in stool and feeling weak and dizzy etc.
If you are getting your 6 month endocopies that should help to keep up on them. Also checking hemoglobin should tell if they are "leaking and about to burst" or not. This is my way of putting it. I'm not a professional or a doctor.
If you are getting your 6 month endocopies that should help to keep up on them. Also checking hemoglobin should tell if they are "leaking and about to burst" or not. This is my way of putting it. I'm not a professional or a doctor.
Took me 2 years to go from grade 1 to grade 3.
By definition varicies imply portal hypertension and borderline compensated/decompensated cirrhosis
By definition varicies imply portal hypertension and borderline compensated/decompensated cirrhosis
Depends on what liver damage you currently have. You get varices with 4th stage liver damage and portal hypertension.
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