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After Having A Ultrasound I Got A Metavir Score Of
Question: After having a Ultrasound I got a Metavir Score of F4, with APRI of 2.17. I have been drinking less than four years and am not a binge drinker. The moment this was diagnosed, I was pulled off a bunch of medicines, and at the moment the only person speaking to me is a PA who is giving alot of information but its all over the place and pretty much makes me think im going to die any day now. How would this be possible?
Brief Answer:
Need more information
Detailed Answer:
Hi,
Thanks for posting your query.
I am Dr.R.K and I am pleased to assist you.
Was biopsy done?
Need more information
Detailed Answer:
Hi,
Thanks for posting your query.
I am Dr.R.K and I am pleased to assist you.
Was biopsy done?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
No other tests were done except blood test. The only ones marked as high were:
Alkaline Phosphatase: 121
AST: 125
ALT: 117
Ferritin: 1311
Alkaline Phosphatase: 121
AST: 125
ALT: 117
Ferritin: 1311
Brief Answer:
Need more information
Detailed Answer:
Hi,
Your liver enzymes and ferritin are quite high.
Was test for hemochromatosis done?
Regards,
Dr.R.K.
Need more information
Detailed Answer:
Hi,
Your liver enzymes and ferritin are quite high.
Was test for hemochromatosis done?
Regards,
Dr.R.K.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
No other tests were done besides the Ultrasound and the blood test
Brief Answer:
Answer given below
Detailed Answer:
Hi,
Thanks for the information.
Just ultrasound scan and blood tests alone are not enough for final diagnosis.
Your ALT and AST are elevated more than 2 times the upper limit of normal which is significant.
Similarly your ferritin is more than 1000 which again is very significant.
Though alcohol intake itself can increase ferritin levels, ferritin of more than 1000 needs to be evaluated further for hemochromatosis. You can discuss with your doctor about getting tested for Hemochromatosis also.
Regards,
Dr.R.K.
Answer given below
Detailed Answer:
Hi,
Thanks for the information.
Just ultrasound scan and blood tests alone are not enough for final diagnosis.
Your ALT and AST are elevated more than 2 times the upper limit of normal which is significant.
Similarly your ferritin is more than 1000 which again is very significant.
Though alcohol intake itself can increase ferritin levels, ferritin of more than 1000 needs to be evaluated further for hemochromatosis. You can discuss with your doctor about getting tested for Hemochromatosis also.
Regards,
Dr.R.K.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have never been tested for Ferritin before this. As far as I can see from my records, my AST and ALT increased on 11/14/2019 for reasons unknown. Before that, all blood tests have them between 20-28. My ALP however, has always been high, within the past 10 blood test, its lowest point was 111. It sounds like you are suggesting I may have a genetic disease with the hemochromatosis, and I do have other medical issues. Besides getting tested for hemochromatosis, do you also have any advice on tests for the liver, or lifestyle? Besides my other medical issues, I feel fine, I just mentioned in passing to my PA that I had pain sometimes where the liver/galbladder is located and she wanted to test. The test results of the ultrasound were also compared and conclusions drawn based on a CT scan of my intestines, not my liver itself. Basically I had a bomb dropped on me with this info on new years eve and they make it sound like I will die any day now.
I spoke to my GI specialist today, he said that I have Compensated cirrhosis with fat on my liver which he said is reversible as long as I eat healthy, exercise and don't drink and sent me some material to read. The material he sent however says that people with Compensated cirrhosis is irreversible and will get worse over time until it cannot perform basic liver functions. I am getting very confused and very anxious, what is your interpretation of this?
Brief Answer:
Answer given below
Detailed Answer:
Hi,
Early compensated cirrhosis due to alcohol intake may be reversible.
But there are other causes of compensated cirrhosis like Hepatitis B , C and metabolic liver disease in which case the cirrhosis may not be reversible.
Cirrhosis is diagnosed if the ultrasound scan shows a shrunken liver with enlarged spleen or fibroscan shows a kPa of more 12.5, APRI score is more than 1.5 or FIB 4 score more than 3.25.
Do you have have any of these?
Also we can suspect cirrhosis if albumin globulin ratio is less than 1.
Regards,
Dr.R.K.
Answer given below
Detailed Answer:
Hi,
Early compensated cirrhosis due to alcohol intake may be reversible.
But there are other causes of compensated cirrhosis like Hepatitis B , C and metabolic liver disease in which case the cirrhosis may not be reversible.
Cirrhosis is diagnosed if the ultrasound scan shows a shrunken liver with enlarged spleen or fibroscan shows a kPa of more 12.5, APRI score is more than 1.5 or FIB 4 score more than 3.25.
Do you have have any of these?
Also we can suspect cirrhosis if albumin globulin ratio is less than 1.
Regards,
Dr.R.K.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have been vaccinated and tested for all three types of hepatitis. The Ultrasound was attached under "FINDINGS.pdf" but I will post the results here
"FINDINGS:Median ARFI (m/sec) = 2.17IQR = 0.28IQR/median = 0.13 (value less than 0.3 indicating a good quality data set)IMPRESSION:METAVIR Stage F4 (>2.0 m/sec)Per SRU consensus statement, METAVIR stages F0 and F1 show low likelihood of having clinically significant fibrosis and no follow up is required. Stages F2 and some F3 show moderate risk of having clinically significant fibrosis and additional testing is appropriate. Some stages of F3 and stage F4 are at high risk of having clinically significant fibrosis and follow up is advised."
As far as Albumin Globulin my results were 4.1 with a standard range of 3.4-5.0.
Based on your prior response, it sounds like I have the possibility to recover? I also still have a hard time understanding how someone who has drank less than 4yrs could have any type of cirrhosis unless they were a binge drinker. Do you have any recommendations besides diet and eating healthy while not drinking?
"FINDINGS:Median ARFI (m/sec) = 2.17IQR = 0.28IQR/median = 0.13 (value less than 0.3 indicating a good quality data set)IMPRESSION:METAVIR Stage F4 (>2.0 m/sec)Per SRU consensus statement, METAVIR stages F0 and F1 show low likelihood of having clinically significant fibrosis and no follow up is required. Stages F2 and some F3 show moderate risk of having clinically significant fibrosis and additional testing is appropriate. Some stages of F3 and stage F4 are at high risk of having clinically significant fibrosis and follow up is advised."
As far as Albumin Globulin my results were 4.1 with a standard range of 3.4-5.0.
Based on your prior response, it sounds like I have the possibility to recover? I also still have a hard time understanding how someone who has drank less than 4yrs could have any type of cirrhosis unless they were a binge drinker. Do you have any recommendations besides diet and eating healthy while not drinking?
Brief Answer:
Answer given below
Detailed Answer:
Hi,
This is not conventional ultrasound.
This is a special test called ARFI which is a newer test and as per the test you have cirrhosis.
You can confirm it with conventional ultrasound or a liver biopsy.
Your albumin is good enough and within normal range and does not indicate chronic liver disease like cirrhosis.
You have mentioned about only the albumin and not the total protein. Only with total protein and albumin I can calculate globulin and albumin globulin ratio.
Just 4 years of alcohol drinking will not result in cirrhosis. So if cirrhosis is confirmed, other causes should be looked in to as mentioned earlier.
In addition to good diet and not drinking, try to maintain appropriate weight for height. Try to maintain your BMI at less than 25. Obesity is one of the risk factors of fatty liver and fatty liver over a period of time can lead to fibrosis and cirrhosis.
Regards,
Dr.R.K.
Answer given below
Detailed Answer:
Hi,
This is not conventional ultrasound.
This is a special test called ARFI which is a newer test and as per the test you have cirrhosis.
You can confirm it with conventional ultrasound or a liver biopsy.
Your albumin is good enough and within normal range and does not indicate chronic liver disease like cirrhosis.
You have mentioned about only the albumin and not the total protein. Only with total protein and albumin I can calculate globulin and albumin globulin ratio.
Just 4 years of alcohol drinking will not result in cirrhosis. So if cirrhosis is confirmed, other causes should be looked in to as mentioned earlier.
In addition to good diet and not drinking, try to maintain appropriate weight for height. Try to maintain your BMI at less than 25. Obesity is one of the risk factors of fatty liver and fatty liver over a period of time can lead to fibrosis and cirrhosis.
Regards,
Dr.R.K.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
This was a FibroScan. AFRI is listed above with a value of 2.17.
In none of your post do I see you asking about protein but it is 7.1 on a 6.4-8.2 standard scale.
I am working on my weight currently, according to my my doctor I really only need to lose 20lbs, which I have already lost 7 and intend to lose more as that just gets me under the weight range he set. My doctor will not do a liver biopsy due to what he would only refer to "people having difficulty with the after effects".
Three questions:
Based on your prior response, it sounds like I have the possibility to recover?
Do you believe in the diagnosis of compensated cirrhosis based on the information I have provided?
To my basic knowledge a needle is used and guided using an ultrasound to take the biopsy which is a very small piece of tissue, what after effects would there be that people have trouble with?
In none of your post do I see you asking about protein but it is 7.1 on a 6.4-8.2 standard scale.
I am working on my weight currently, according to my my doctor I really only need to lose 20lbs, which I have already lost 7 and intend to lose more as that just gets me under the weight range he set. My doctor will not do a liver biopsy due to what he would only refer to "people having difficulty with the after effects".
Three questions:
Based on your prior response, it sounds like I have the possibility to recover?
Do you believe in the diagnosis of compensated cirrhosis based on the information I have provided?
To my basic knowledge a needle is used and guided using an ultrasound to take the biopsy which is a very small piece of tissue, what after effects would there be that people have trouble with?
Brief Answer:
Answer given below
Detailed Answer:
Hi,,
In the liver panel, only total protein and albumin are tested. Globulin is calculated by subtracting albumin from total protein. In some of the labs they do this calculation and mention about the globulin also in the report.
You mentioned only about albumin (4.1) and not globulin and I was not able to calculate the ratio. I thought may be your report is not showing the globulin and so I wanted total protein so that I can calculate globulin and after that the ratio.
Your total protein is 7.1
Albumin is 4.1
So Globulin is (7.1-4.1) 3
The albumin globulin ratio is more than 1
Albumin is synthesized in the liver and since it is normal, your liver function is normal
Since the albumin globulin ratio is more than 1, it rules out chronic liver disease like cirrhosis.
But your scan shows you have F4 which is cirrhosis.
Since these two are contradicting each other, I told you to get a biopsy done which is confirmatory.
Regarding your three questions -
1. Yes, you have a possibility to recover
2. The diagnosis of compensatory cirrhosis is not confirmed for the reason I have described above
3. There will not be any serious after effects with liver biopsy especially if the liver function is good. Your doctor would perform a blood test called PT/INR before proceeding with the biopsy. You might have mild pain at the biopsy site for a day or two.
Regards,
Dr.R.K.
Answer given below
Detailed Answer:
Hi,,
In the liver panel, only total protein and albumin are tested. Globulin is calculated by subtracting albumin from total protein. In some of the labs they do this calculation and mention about the globulin also in the report.
You mentioned only about albumin (4.1) and not globulin and I was not able to calculate the ratio. I thought may be your report is not showing the globulin and so I wanted total protein so that I can calculate globulin and after that the ratio.
Your total protein is 7.1
Albumin is 4.1
So Globulin is (7.1-4.1) 3
The albumin globulin ratio is more than 1
Albumin is synthesized in the liver and since it is normal, your liver function is normal
Since the albumin globulin ratio is more than 1, it rules out chronic liver disease like cirrhosis.
But your scan shows you have F4 which is cirrhosis.
Since these two are contradicting each other, I told you to get a biopsy done which is confirmatory.
Regarding your three questions -
1. Yes, you have a possibility to recover
2. The diagnosis of compensatory cirrhosis is not confirmed for the reason I have described above
3. There will not be any serious after effects with liver biopsy especially if the liver function is good. Your doctor would perform a blood test called PT/INR before proceeding with the biopsy. You might have mild pain at the biopsy site for a day or two.
Regards,
Dr.R.K.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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