Aa
Cirrhosis and Atherosclerosis
AGE: 41
Alcoholic cirrhosis diagnosed nearly 4 years ago/maintains sobriety
MELD: 12
Symptoms of decompensated cirrhosis include: Grade 3 non-bleeding Varices and Hepatic Encephalopathy “controlled”.
CT Scan Results:
IMPRESSION:
1. This patient with findings of cirrhosis and portal hypertension, there appears to be an increased size of a hypervascular focus near the junction of the true right and left lobes superiorly, that is at the junction of subsegments VIII and IVA. The attenuation is similar to the hepatic arterial structures, and this could represent a vascular malformation, although it certainly could also represent hepatocellular carcinoma or shunting related to a small focus of hepatocellular carcinoma. Followup imaging with MR in the future may be useful for further evaluation.
2. At least two additional peripheral mildly hypervascular foci are also seen which could represent THAD formation rather than true hepatocellular carcinoma, and this could be followed routinely, also better evaluated with MR.
3. Portal hypertension include splenomegaly and variceal formation as described.
4. Atherosclerotic disease including mild renal scarring.
5. A nodular focus in the left lateral sulcus is along a band of atelectasis or more likely scarring. Although this was not as evident on the prior study, there is the suggestion that similar bands of atelectasis /scarring were present on a 2011 CT. This could be followed routinely.
6. Umbilical herniation of omental fat.
Alcoholic cirrhosis diagnosed nearly 4 years ago/maintains sobriety
MELD: 12
Symptoms of decompensated cirrhosis include: Grade 3 non-bleeding Varices and Hepatic Encephalopathy “controlled”.
CT Scan Results:
IMPRESSION:
1. This patient with findings of cirrhosis and portal hypertension, there appears to be an increased size of a hypervascular focus near the junction of the true right and left lobes superiorly, that is at the junction of subsegments VIII and IVA. The attenuation is similar to the hepatic arterial structures, and this could represent a vascular malformation, although it certainly could also represent hepatocellular carcinoma or shunting related to a small focus of hepatocellular carcinoma. Followup imaging with MR in the future may be useful for further evaluation.
2. At least two additional peripheral mildly hypervascular foci are also seen which could represent THAD formation rather than true hepatocellular carcinoma, and this could be followed routinely, also better evaluated with MR.
3. Portal hypertension include splenomegaly and variceal formation as described.
4. Atherosclerotic disease including mild renal scarring.
5. A nodular focus in the left lateral sulcus is along a band of atelectasis or more likely scarring. Although this was not as evident on the prior study, there is the suggestion that similar bands of atelectasis /scarring were present on a 2011 CT. This could be followed routinely.
6. Umbilical herniation of omental fat.
Hello John,
It’s nice to hear from you again. I am treated at Vanderbilt transplant center here in Nashville. They have a wonderful communications system in place. I simply log in to my account and I have access to all of my medial files to include anything from radiology to lab testing. They also have an email system in place where I can contact my doctor directly, make payments, request prescriptions and schedule/reschedule appointments. As you can imagine this has been very beneficial for me but I still like to do my own research so I can better communicate treatment options with my doctors along with the opinions and experience form experts such as yourself is most helpful in ensuring nothing is missed and the best approach is taken. I really appreciate all the time you have taken to respond. Us MedHelp members are very fortunate to have you.
I have not met with my Hepatologist to go over the findings of my CT scan but she had taken the time to sit down with the radiologist to go over the imaging at which point she called to let me know that almost for certain I do not have HCC. She also mentioned the scaring on my kidneys is so minimal it’s not worth pursuing. Creatinine Blood: 0.64* mg/dL (0.70-1.50) indicating excellent renal function. The calcium scan is still of concern and in January I will have a lipid panel ran to see how much improvement the change in my diet has made.
Stress echocardiogram were over-all good and of no concern.
Conclusions: 1. Good exercise capacity without chest pain.
2. ECG with nondiagnostic STT changes.
3. Resting echo showed normal LV wall motion and systolic function. With exercise there was a normal augmentation of wall motion and systolic function with no new regional wall motion abnormalities.
4. Resting echo shows dilated RV with normal systolic function.
It still strikes me as strange a TL. Cholesterol-136 created any problems for me. I will also be due to meet with my PCP for routine lab work CMP/CBC primarily to monitor liver function but I don’t expect any advancement if anything may be a little improvement with the new diet. Maintaining my diet and sobriety are my key to living a normal life expectancy without transplant or development of HCC.
“ I know this time of year can be pretty rough. Are you involved with any groups/sponsors?”
My diagnosis was all the motivation I have ever needed. At that point I realized I had an obligation to my wife and daughters to do this for them. I had been selfish long enough, everything evolved around that drink. I tapered my beers from 23 a day to 0 in less than a week since I have never considered the idea but I sure understand that it is difficult for many others. I enjoy participating in MedHelp”s Alcoholism community and I am the CL of the Cirrhosis community. I love the opportunity to help someone change their life and maybe see how much better life can be without alcohol. Also learning to live with liver disease can be difficult so I like to help others that are still learning or scared, maybe even give them some hope. I believe it can give them enough motivation to make a difference or at least that’s what I hope!
John I am glad to see your community is establishing quite well and I hope you have a wonderful holiday if I don’t hear back from you before then. In January I will get back to you with my lipid panel results just for fun and satisfy any curiosity.
Take care,
Randy
It’s nice to hear from you again. I am treated at Vanderbilt transplant center here in Nashville. They have a wonderful communications system in place. I simply log in to my account and I have access to all of my medial files to include anything from radiology to lab testing. They also have an email system in place where I can contact my doctor directly, make payments, request prescriptions and schedule/reschedule appointments. As you can imagine this has been very beneficial for me but I still like to do my own research so I can better communicate treatment options with my doctors along with the opinions and experience form experts such as yourself is most helpful in ensuring nothing is missed and the best approach is taken. I really appreciate all the time you have taken to respond. Us MedHelp members are very fortunate to have you.
I have not met with my Hepatologist to go over the findings of my CT scan but she had taken the time to sit down with the radiologist to go over the imaging at which point she called to let me know that almost for certain I do not have HCC. She also mentioned the scaring on my kidneys is so minimal it’s not worth pursuing. Creatinine Blood: 0.64* mg/dL (0.70-1.50) indicating excellent renal function. The calcium scan is still of concern and in January I will have a lipid panel ran to see how much improvement the change in my diet has made.
Stress echocardiogram were over-all good and of no concern.
Conclusions: 1. Good exercise capacity without chest pain.
2. ECG with nondiagnostic STT changes.
3. Resting echo showed normal LV wall motion and systolic function. With exercise there was a normal augmentation of wall motion and systolic function with no new regional wall motion abnormalities.
4. Resting echo shows dilated RV with normal systolic function.
It still strikes me as strange a TL. Cholesterol-136 created any problems for me. I will also be due to meet with my PCP for routine lab work CMP/CBC primarily to monitor liver function but I don’t expect any advancement if anything may be a little improvement with the new diet. Maintaining my diet and sobriety are my key to living a normal life expectancy without transplant or development of HCC.
“ I know this time of year can be pretty rough. Are you involved with any groups/sponsors?”
My diagnosis was all the motivation I have ever needed. At that point I realized I had an obligation to my wife and daughters to do this for them. I had been selfish long enough, everything evolved around that drink. I tapered my beers from 23 a day to 0 in less than a week since I have never considered the idea but I sure understand that it is difficult for many others. I enjoy participating in MedHelp”s Alcoholism community and I am the CL of the Cirrhosis community. I love the opportunity to help someone change their life and maybe see how much better life can be without alcohol. Also learning to live with liver disease can be difficult so I like to help others that are still learning or scared, maybe even give them some hope. I believe it can give them enough motivation to make a difference or at least that’s what I hope!
John I am glad to see your community is establishing quite well and I hope you have a wonderful holiday if I don’t hear back from you before then. In January I will get back to you with my lipid panel results just for fun and satisfy any curiosity.
Take care,
Randy
MEDICAL PROFESSIONAL
Oh yeah keep up the good work on the diet and great work on the sobriety! I know this time of year can be pretty rough. Are you involved with any groups/sponsors?
MEDICAL PROFESSIONAL
Hi Randy,
That's awesome news! It looks like (keeping in mind I'm not a radiologist) that everything is remaining stable if not improving based on your scans, although everything needs to be taken in context with your overall health. Have you had your follow up appointment to go over the results of your CAT scan? The radiologists can't always determine what some of the findings are in the liver but usually when things are getting smaller it's a good thing. Thanks for taking the time to type out all of that info, I know it takes a lot of time but it definitely helps me understand what's going on.
Take care,
John
That's awesome news! It looks like (keeping in mind I'm not a radiologist) that everything is remaining stable if not improving based on your scans, although everything needs to be taken in context with your overall health. Have you had your follow up appointment to go over the results of your CAT scan? The radiologists can't always determine what some of the findings are in the liver but usually when things are getting smaller it's a good thing. Thanks for taking the time to type out all of that info, I know it takes a lot of time but it definitely helps me understand what's going on.
Take care,
John
Hello John, I hope you are doing well.
On 12/05/13 I had a follow-up CT scan W/without contrast. I am pleased to see they have ruled out hepatocellular carcinoma. I have still been sticking with my new diet in my best effort to address atherosclerosis. Is there anything else you feel is pertinent to elaborate concerning the following findings?
FINDINGS:
1. The nodule or focus in the left lower lobe at the in the lateral sulcus of the anterior medial basal segment is less prominent when compared with prior exam of 8/26/2013 this measures approximately 6 mm x 3 mm compared with 7 mm x 5 mm on prior exam this may represent residual scarring or atelectasis.
2. The liver maintains a nodular contour consistent with cirrhosis. The ill-defined hypervascular focus superiorly in the liver near the junction of the right and left lobes is visible however less distinct when compared with prior examination. There are continued areas ill-defined band of decreased attenuation within the liver. Additionally previously described mild hypervascular foci is seen near the dome of the liver in the left and right lobes are also less distinct when compared to prior.
3. The spleen is markedly enlarged measuring up to 20 cm in greatest axial dimension consistent with sequela of portal hypertension. Small gastroesophageal varices are present as well as a recanalized umbilical vein. Multiple small collateral vessels are also seen extending into the umbilical herniation of omental fat.
4. The multiple borderline periportal, gastrohepatic comment. Pancreatic lymph nodes are stable in size and appearance.
5. The pancreas and adrenal glands are normal in appearance. Minimal renal scarring is unchanged. Multiple gallstones are present within the gallbladder lumen. There is a probable small splenule at the anterior aspect of the spleen.
6. The bowel is nonobstructed. The appendix is normal. There is no significant free intraperitoneal fluid.
7. The bones are intact without osteolytic or blastic lesion.
8. Atherosclerosis is demonstrated within the abdominal aorta and its branching vessels.
CONCLUSION:
1. Continued findings of cirrhosis and portal hypertension with gastroesophageal varices and splenomegaly. A faint hypervascular focus is seen at the junction of the true left and right lobes superiorly which is less distinct when compared with the prior examination of 8/26/2013. The 2 additional peripherally mildly hypervascular foci also seen on prior exam are poorly characterized on today's study.
2. Nodular focus in the left lateral sulcus of the base of the left lower lobe is less distinct and likely represents atelectasis or scarring.
3. Fat-containing umbilical hernia
Thanks, Randy
On 12/05/13 I had a follow-up CT scan W/without contrast. I am pleased to see they have ruled out hepatocellular carcinoma. I have still been sticking with my new diet in my best effort to address atherosclerosis. Is there anything else you feel is pertinent to elaborate concerning the following findings?
FINDINGS:
1. The nodule or focus in the left lower lobe at the in the lateral sulcus of the anterior medial basal segment is less prominent when compared with prior exam of 8/26/2013 this measures approximately 6 mm x 3 mm compared with 7 mm x 5 mm on prior exam this may represent residual scarring or atelectasis.
2. The liver maintains a nodular contour consistent with cirrhosis. The ill-defined hypervascular focus superiorly in the liver near the junction of the right and left lobes is visible however less distinct when compared with prior examination. There are continued areas ill-defined band of decreased attenuation within the liver. Additionally previously described mild hypervascular foci is seen near the dome of the liver in the left and right lobes are also less distinct when compared to prior.
3. The spleen is markedly enlarged measuring up to 20 cm in greatest axial dimension consistent with sequela of portal hypertension. Small gastroesophageal varices are present as well as a recanalized umbilical vein. Multiple small collateral vessels are also seen extending into the umbilical herniation of omental fat.
4. The multiple borderline periportal, gastrohepatic comment. Pancreatic lymph nodes are stable in size and appearance.
5. The pancreas and adrenal glands are normal in appearance. Minimal renal scarring is unchanged. Multiple gallstones are present within the gallbladder lumen. There is a probable small splenule at the anterior aspect of the spleen.
6. The bowel is nonobstructed. The appendix is normal. There is no significant free intraperitoneal fluid.
7. The bones are intact without osteolytic or blastic lesion.
8. Atherosclerosis is demonstrated within the abdominal aorta and its branching vessels.
CONCLUSION:
1. Continued findings of cirrhosis and portal hypertension with gastroesophageal varices and splenomegaly. A faint hypervascular focus is seen at the junction of the true left and right lobes superiorly which is less distinct when compared with the prior examination of 8/26/2013. The 2 additional peripherally mildly hypervascular foci also seen on prior exam are poorly characterized on today's study.
2. Nodular focus in the left lateral sulcus of the base of the left lower lobe is less distinct and likely represents atelectasis or scarring.
3. Fat-containing umbilical hernia
Thanks, Randy
MEDICAL PROFESSIONAL
That's awesome Randy, keep up the good fight and we'll all keep our fingers crossed that those numbers are moving in the right direction. We're all looking forward to seeing how you're doing, stay in touch!
John
John
Thanks John,
You have been very helpful, it’s been refreshing to hear that I may have taken a better path. My Hepatologist is very clever and I get the feeling so is my cardiologist so I am hesitant to question any treatment they suggest but I got to tell you, things are going good and I am looking forward to my next lipid panel! :)
I’ll be sure to post you those results in January, again thank you and Good luck with your new group! We are lucky to have you part of MedHelp!
Randy
You have been very helpful, it’s been refreshing to hear that I may have taken a better path. My Hepatologist is very clever and I get the feeling so is my cardiologist so I am hesitant to question any treatment they suggest but I got to tell you, things are going good and I am looking forward to my next lipid panel! :)
I’ll be sure to post you those results in January, again thank you and Good luck with your new group! We are lucky to have you part of MedHelp!
Randy
MEDICAL PROFESSIONAL
Hi Randy,
Thanks for the feedback. I'm looking forward to seeing how everything goes for you in the near future. I like the thought of the cardiologist saying to try diet and exercise for the next couple of months then rechecking your levels. I'll be thinking of you, be sure to let me know how you're doing from time to time.
Good luck!
John
Thanks for the feedback. I'm looking forward to seeing how everything goes for you in the near future. I like the thought of the cardiologist saying to try diet and exercise for the next couple of months then rechecking your levels. I'll be thinking of you, be sure to let me know how you're doing from time to time.
Good luck!
John
John thank you so much for your response.
Since posting here is where things are at:
Though receiving the approval from my Hepatologist to begin taking a statin the decision has weighed heavily on my mind. In my circumstance my liver can safely recover from a certain amount of damage caused from processing the drug according to my Hepatologist, and in the event of a major coronary episode dead myocardium (heart tissue) cannot be brought back. I still feel it’s not worth the risk at this point so I have opted not to take the advice of the cardio specialist and make things simpler. Diet and exercise was never suggested by either doctor and yet it brings the most benefit to my cardiovascular disease and liver health. Sure were told to do it after diagnosis and some of us do but some of us don’t. The labs keep coming back consistent and that’s that. In my opinion this should have been the first question/suggestion from either doctor. The cardio specialist has agreed that it is safe to try it my way for the next couple of months at which point we will retest. Goal being to get my cholesterol down to 100.
My HDL Cholesterol is- 37 (>=41). NO symptoms of coronary disease have manifested (i.e. Chest pain or irregular heart rhythm). It was the CT Scan that prompted the calcium score test. In February this year my cholesterol tl. -156. Now for the past month since the calcium score test I have changed my diet and cholesterol tl -136. This has also prompted my heart rate to drop to low 40’s on three occasions so I lowered my propranolol BP medication from 80mg er to 60mg er to maintain my heart rate between 55-60bpm as a recommended heart rate by my Hepatologist for treatment of my varices.
I’m hoping I have chosen the right path here since I pushed so hard to persuade my doctors this is the best route to take against their initial response to begin a statin. Time will tell and I can also begin the Lipitor at such a point calls for it.
Since posting here is where things are at:
Though receiving the approval from my Hepatologist to begin taking a statin the decision has weighed heavily on my mind. In my circumstance my liver can safely recover from a certain amount of damage caused from processing the drug according to my Hepatologist, and in the event of a major coronary episode dead myocardium (heart tissue) cannot be brought back. I still feel it’s not worth the risk at this point so I have opted not to take the advice of the cardio specialist and make things simpler. Diet and exercise was never suggested by either doctor and yet it brings the most benefit to my cardiovascular disease and liver health. Sure were told to do it after diagnosis and some of us do but some of us don’t. The labs keep coming back consistent and that’s that. In my opinion this should have been the first question/suggestion from either doctor. The cardio specialist has agreed that it is safe to try it my way for the next couple of months at which point we will retest. Goal being to get my cholesterol down to 100.
My HDL Cholesterol is- 37 (>=41). NO symptoms of coronary disease have manifested (i.e. Chest pain or irregular heart rhythm). It was the CT Scan that prompted the calcium score test. In February this year my cholesterol tl. -156. Now for the past month since the calcium score test I have changed my diet and cholesterol tl -136. This has also prompted my heart rate to drop to low 40’s on three occasions so I lowered my propranolol BP medication from 80mg er to 60mg er to maintain my heart rate between 55-60bpm as a recommended heart rate by my Hepatologist for treatment of my varices.
I’m hoping I have chosen the right path here since I pushed so hard to persuade my doctors this is the best route to take against their initial response to begin a statin. Time will tell and I can also begin the Lipitor at such a point calls for it.
MEDICAL PROFESSIONAL
Sorry I just saw your other questions. The CT findings are consistent with cirrhosis along with areas that are recommended for additional followup including MRI. The calcium score for your coronary arteries is worrisome which may be why your cardiologist is suggesting Lipitor. Your bad cholesterol (LDL) is great along with your total cholesterol. I don't see a value for HDL (good cholesterol) listed although this may be low based upon the TC:HDL ratio that you've listed. It may be helpful to ask what the goal of the Lipitor would be and whether this could be achieved by diet and exercise. I'm not sure as to whether calcium scores can be corrected through lifestyle changes.
MEDICAL PROFESSIONAL
Hi Randy,
Sorry for the delayed response. I've been traveling and just now am getting internet access back again. This is a tough question to answer and one that is appreciate your insight on. Let me start by saying I'm not a cardiologist so take everything I say with a grain of salt. I completely understand not wanting to start a new medication, especially with a history of liver problems. That being said I usually am a full supporter of trying to modify your lifestyle before starting a new medication. If you think that modifying your diet and starting a regular exercise program are things you will maintain in your life (realizing that it's a lifetime investment, not a short term goal) then I would say go for it. If you try your best and the numbers just don't show the results that you need then I think you would need to explore another avenue. Lastly, we only get one heart and need to do everything we can to protect its health. Just food for thought. I might forward this post to the internal medicine specialists on here as this isn't my area of expertise and there are a lot of factors/variables that I can't appreciate through a forum chat. I hope that this information helps and would like to hear any feedback that you have and what you decide on. I apologize for any typos, I'm writing from my phone and am trying to learn how to navigate this forum. Congrats on the sobriety, that's a wonderful thing to hear.
Wishing you the best,
John
Sorry for the delayed response. I've been traveling and just now am getting internet access back again. This is a tough question to answer and one that is appreciate your insight on. Let me start by saying I'm not a cardiologist so take everything I say with a grain of salt. I completely understand not wanting to start a new medication, especially with a history of liver problems. That being said I usually am a full supporter of trying to modify your lifestyle before starting a new medication. If you think that modifying your diet and starting a regular exercise program are things you will maintain in your life (realizing that it's a lifetime investment, not a short term goal) then I would say go for it. If you try your best and the numbers just don't show the results that you need then I think you would need to explore another avenue. Lastly, we only get one heart and need to do everything we can to protect its health. Just food for thought. I might forward this post to the internal medicine specialists on here as this isn't my area of expertise and there are a lot of factors/variables that I can't appreciate through a forum chat. I hope that this information helps and would like to hear any feedback that you have and what you decide on. I apologize for any typos, I'm writing from my phone and am trying to learn how to navigate this forum. Congrats on the sobriety, that's a wonderful thing to hear.
Wishing you the best,
John
Calcium score test was ran- results: 570- high risk category and coronary arterial age in years is 85.
Lipid panel, results are as follows:
CHOLESTEROL BLOOD TL: 136 mg/dL (<=199)
TRIGLYCERIDES BLOOD: 60 mg/dL (=41)
LDL CHOLESTEROL CALC: 87 mg/dL (1-129)
TC:HDL: 3.7
EKG and Stress Echo NORMAL FINDINGS.
Questions: What is your interpretation of these tests and is it fitting to begin treating atherosclerosis with a statin “Lipitor” per the suggestion of my cardiologist. I have expressed my concerns regarding the use of the statin and would like to try diet and exercise first. Does this seem feasible? I appreciate your reply.
Randy
Lipid panel, results are as follows:
CHOLESTEROL BLOOD TL: 136 mg/dL (<=199)
TRIGLYCERIDES BLOOD: 60 mg/dL (=41)
LDL CHOLESTEROL CALC: 87 mg/dL (1-129)
TC:HDL: 3.7
EKG and Stress Echo NORMAL FINDINGS.
Questions: What is your interpretation of these tests and is it fitting to begin treating atherosclerosis with a statin “Lipitor” per the suggestion of my cardiologist. I have expressed my concerns regarding the use of the statin and would like to try diet and exercise first. Does this seem feasible? I appreciate your reply.
Randy
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