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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I just had a US LIVER ELASTOGRAPHY and it indicated

Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2038 Questions

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Posted on Sat, 5 Jan 2019 in Liver and Gall Bladder
Question: I just had a US LIVER ELASTOGRAPHY and it indicated mild to moderate liver stiffness, MetaVir score of F1-F2. That is somewhere between minimal fibrosis and severe fibrosis or cirrhosis. I have autoimmune hepatitis and fatty liver and active replicating Epstien Barr virus. Which condition would cause my stiff liver and how bad is it? Should I have a liver biopsy to diagnose my condition? How can I prevent it getting worse?

Here are my test results:
FINDINGS:

Pancreas: Partially visualized and unremarkable.

Liver: Normal in size and homogeneous in echogenicity.

Focal liver lesions: None.

Portal vein: Normal, hepatopetal flow.

Bile ducts: Normal in caliber.

Gallbladder: Normally distended with no gallstones, gallbladder wall thickening, or sonographic Murphy's sign. Small hyperechoic focus adherent to the gallbladder wall measuring 3 mm, likely representing a polyp.

Kidneys: Normal in size with normal cortical thickness and echogenicity. No hydronephrosis.

Spleen: Normal in size.

Ascites: None in the upper abdomen.

Visualized proximal aorta and IVC: Unremarkable.

MEASUREMENTS:
Liver: 14.7 cm
Common Duct: 7 mm
Right Kidney: 9.9 cm
Left Kidney: 10.1 cm
Spleen: 7.4 cm
Aorta: 2.1 cm

SHEAR WAVE LIVER STIFFNESS MEASUREMENTS: Mean 1.57 +/-0.1 m/sec, Median 1.57 m/sec, equating to 7.53 kPa. IQR/Med = 19 %ile.

REFERENCE (m/s, kPa):
Normal: 0.81-1.22 m/s 2.0-4.5 kPa (METAVIR F0)
Normal/mild: 1.22-1.37 m/s 4.5-5.7 kPa (METAVIR F0-F1)
Mild/moderate: 1.37-2 m/s 5.7-12.0 kPa (METAVIR F1-F2)
Moderate/severe: 2-2.64 m/s 12.0-21.0 kPa (METAVIR F2-F3)
Severe: >2.64 m/s >21.0 kPa (METAVIR F4)
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Follow up: Dr. Ramesh Kumar 0 minute later
I just had a US LIVER ELASTOGRAPHY and it indicated mild to moderate liver stiffness, MetaVir score of F1-F2. That is somewhere between minimal fibrosis and severe fibrosis or cirrhosis. I have autoimmune hepatitis and fatty liver and active replicating Epstien Barr virus. Which condition would cause my stiff liver and how bad is it? Should I have a liver biopsy to diagnose my condition? How can I prevent it getting worse?

Here are my test results:
FINDINGS:

Pancreas: Partially visualized and unremarkable.

Liver: Normal in size and homogeneous in echogenicity.

Focal liver lesions: None.

Portal vein: Normal, hepatopetal flow.

Bile ducts: Normal in caliber.

Gallbladder: Normally distended with no gallstones, gallbladder wall thickening, or sonographic Murphy's sign. Small hyperechoic focus adherent to the gallbladder wall measuring 3 mm, likely representing a polyp.

Kidneys: Normal in size with normal cortical thickness and echogenicity. No hydronephrosis.

Spleen: Normal in size.

Ascites: None in the upper abdomen.

Visualized proximal aorta and IVC: Unremarkable.

MEASUREMENTS:
Liver: 14.7 cm
Common Duct: 7 mm
Right Kidney: 9.9 cm
Left Kidney: 10.1 cm
Spleen: 7.4 cm
Aorta: 2.1 cm

SHEAR WAVE LIVER STIFFNESS MEASUREMENTS: Mean 1.57 +/-0.1 m/sec, Median 1.57 m/sec, equating to 7.53 kPa. IQR/Med = 19 %ile.

REFERENCE (m/s, kPa):
Normal: 0.81-1.22 m/s 2.0-4.5 kPa (METAVIR F0)
Normal/mild: 1.22-1.37 m/s 4.5-5.7 kPa (METAVIR F0-F1)
Mild/moderate: 1.37-2 m/s 5.7-12.0 kPa (METAVIR F1-F2)
Moderate/severe: 2-2.64 m/s 12.0-21.0 kPa (METAVIR F2-F3)
Severe: >2.64 m/s >21.0 kPa (METAVIR F4)
doctor
Answered by Dr. Ramesh Kumar 57 minutes later
Brief Answer:
Autoimmune hepatitis

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.

Fibro optic scan is suggestive of mild to moderate level of damage to your liver as you yourself can read in the report. This damage is a result of autoimmune Hepatitis. Your immunity attacks your own liver cells and injures them. As a result of this injury your body start depositing more fibers in that area to strengthen the liver as a result of which elasticity decreases. Right now the disease is fully controllable in your case by proper medication and liver friendly diet.

Initially start taking a immuno-suppressant like cyclophosphamide on suggestion of your primary doctor. This would prevent further liver injury and fibrosis.

As far as fatty liver is concerned it's a age related problem and could be reversed by following proper diet-

Suggestions-
Whole grains are very beneficial to consume.
-Fruits and vegetables should be a significant part of any diet to help in recovering from a liver disease. They are full of essential nutrients and are easy to digest.
-Healthy proteins in the form of low-fat milk and dairy products along with lean meats, beans, eggs and soy products can also be a part of a healthy liver diet.
-Avoid red meat.
Try to switch over to veg diet.
Take anti oxidants daily.
Take sylimarin daily it's a very potent liver rejevunators.
You have a polyp too in gall bladder. Get it removed by a planned laproscopic cholecystectomy.

Hope I cleared your doubts.
Feel free to follow up.
Regards!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Autoimmune hepatitis

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.

Fibro optic scan is suggestive of mild to moderate level of damage to your liver as you yourself can read in the report. This damage is a result of autoimmune Hepatitis. Your immunity attacks your own liver cells and injures them. As a result of this injury your body start depositing more fibers in that area to strengthen the liver as a result of which elasticity decreases. Right now the disease is fully controllable in your case by proper medication and liver friendly diet.

Initially start taking a immuno-suppressant like cyclophosphamide on suggestion of your primary doctor. This would prevent further liver injury and fibrosis.

As far as fatty liver is concerned it's a age related problem and could be reversed by following proper diet-

Suggestions-
Whole grains are very beneficial to consume.
-Fruits and vegetables should be a significant part of any diet to help in recovering from a liver disease. They are full of essential nutrients and are easy to digest.
-Healthy proteins in the form of low-fat milk and dairy products along with lean meats, beans, eggs and soy products can also be a part of a healthy liver diet.
-Avoid red meat.
Try to switch over to veg diet.
Take anti oxidants daily.
Take sylimarin daily it's a very potent liver rejevunators.
You have a polyp too in gall bladder. Get it removed by a planned laproscopic cholecystectomy.

Hope I cleared your doubts.
Feel free to follow up.
Regards!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 8 hours later
Thank you for your answer. It was very helpful.

I am scheduled to start cytoxan in a couple of weeks, for six months. Low dose of 20 mg, half of usual dose for cancer. Is this correct? What side effects will I have with that dose?

I have lost 10 pounds in the last six weeks, and will continue until I lose the remaining 30 pounds to achieve BMI of 22. It is 29 right now. That should remove the fatty liver, right?

I will take the sylimarin daily, which I have a 90-day supply on order from Dr. Mercola called Liver Support. https://shop.mercola.com/product/1859/liver-support-60-per-bottle-90-day-supply

I am a vegetarian, so already eat the diet you mentioned and never eat red meat. I will start taking antioxidants. What ones do you suggest I take?

Is the gallbladder polyp large enough to warrant removal? It is only 3mm. Could it be cancerouse? To get the polyp removed in my gallbladder, does the whole gallbladder have to be removed, or just the polyp? Can this happen as an outpatient or do I have to be admitted to the hospital? If I don't get the polyp removed, what could be the consequences?
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Follow up: Dr. Ramesh Kumar 0 minute later
Thank you for your answer. It was very helpful.

I am scheduled to start cytoxan in a couple of weeks, for six months. Low dose of 20 mg, half of usual dose for cancer. Is this correct? What side effects will I have with that dose?

I have lost 10 pounds in the last six weeks, and will continue until I lose the remaining 30 pounds to achieve BMI of 22. It is 29 right now. That should remove the fatty liver, right?

I will take the sylimarin daily, which I have a 90-day supply on order from Dr. Mercola called Liver Support. https://shop.mercola.com/product/1859/liver-support-60-per-bottle-90-day-supply

I am a vegetarian, so already eat the diet you mentioned and never eat red meat. I will start taking antioxidants. What ones do you suggest I take?

Is the gallbladder polyp large enough to warrant removal? It is only 3mm. Could it be cancerouse? To get the polyp removed in my gallbladder, does the whole gallbladder have to be removed, or just the polyp? Can this happen as an outpatient or do I have to be admitted to the hospital? If I don't get the polyp removed, what could be the consequences?
doctor
Answered by Dr. Ramesh Kumar 18 hours later
Brief Answer:
follow up.

Detailed Answer:
Hello my dear patient and thanks for follow up,
I am sorry for a bit delayed reply,
1)When used as the only oncolytic drug therapy, the initial course of CYTOXAN for patients with no hematologic deficiency usually consists of 40 to 50 mg/kg given intravenously in divided doses over a period of 2 to 5 days. Other intravenous regimens include 10 to 15 mg/kg given every 7 to 10 days or 3 to 5 mg/kg twice weekly.
Your dose is nothing as compared to such high doses used for cancer.In your case its used for immunosupression and not for chemotherapy.Mild nausea vomiting dizziness etc are usual side effect at low doses.Don't read too much about that.You would feel what ever your brain would read.
Yes fatty lever just means an obese lever just as a person gains fat and become obese(peripheral obesity can be seen by eyes) when liver gains fat and become obese its called fatty liver(inspite of eyes we use ultrasound rays to see visceral obesity).
As you would loose those extra pounds your liver would loose fat too.Take supplement YOHIMBINE for getting rid of fat easily.
Yah sylimarin is good you can take it or you can prefer any other sport brand based company like GNC,Myprotein etc for purity.

Any anti oxidant containing chromium copper zinc magnesium ginseng etc.(with 500 grams of colored seasonal fruits)

Frankly speaking no one knows if gall bladder polyp is benign or malignant.However in most cases polyp smaller then 5 mm and solitary are usually benign.So if you want to take a chance you can go by data.
Option 2 Biopsy sample of the polyp would be taken by interventional method.
3)Easiest and safest -Go for laproscopic removal of gallbladder.Practically a useless organ.No further tests follow ups etc would be required.


To get the polyp removed in my gallbladder, does the whole gallbladder have to be removed, or just the polyp?-Full gallbladder
Can this happen as an outpatient or do I have to be admitted to the hospital? If you opt for laproscopic surgery 24 hours time is usual discharge period.
If I don't get the polyp removed, what could be the consequences?-Every 6 month follow ups.If size increases or it blockes the passage of duct of bladder then pain etc....Finally one day you have to get it operated only.
Hope i was easy to understand,
Please feel free to follow up whatever you want to ask or any confusions.
If you have any suggestions to make answers better feel free to suggest.
God bless you and Regards!
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
follow up.

Detailed Answer:
Hello my dear patient and thanks for follow up,
I am sorry for a bit delayed reply,
1)When used as the only oncolytic drug therapy, the initial course of CYTOXAN for patients with no hematologic deficiency usually consists of 40 to 50 mg/kg given intravenously in divided doses over a period of 2 to 5 days. Other intravenous regimens include 10 to 15 mg/kg given every 7 to 10 days or 3 to 5 mg/kg twice weekly.
Your dose is nothing as compared to such high doses used for cancer.In your case its used for immunosupression and not for chemotherapy.Mild nausea vomiting dizziness etc are usual side effect at low doses.Don't read too much about that.You would feel what ever your brain would read.
Yes fatty lever just means an obese lever just as a person gains fat and become obese(peripheral obesity can be seen by eyes) when liver gains fat and become obese its called fatty liver(inspite of eyes we use ultrasound rays to see visceral obesity).
As you would loose those extra pounds your liver would loose fat too.Take supplement YOHIMBINE for getting rid of fat easily.
Yah sylimarin is good you can take it or you can prefer any other sport brand based company like GNC,Myprotein etc for purity.

Any anti oxidant containing chromium copper zinc magnesium ginseng etc.(with 500 grams of colored seasonal fruits)

Frankly speaking no one knows if gall bladder polyp is benign or malignant.However in most cases polyp smaller then 5 mm and solitary are usually benign.So if you want to take a chance you can go by data.
Option 2 Biopsy sample of the polyp would be taken by interventional method.
3)Easiest and safest -Go for laproscopic removal of gallbladder.Practically a useless organ.No further tests follow ups etc would be required.


To get the polyp removed in my gallbladder, does the whole gallbladder have to be removed, or just the polyp?-Full gallbladder
Can this happen as an outpatient or do I have to be admitted to the hospital? If you opt for laproscopic surgery 24 hours time is usual discharge period.
If I don't get the polyp removed, what could be the consequences?-Every 6 month follow ups.If size increases or it blockes the passage of duct of bladder then pain etc....Finally one day you have to get it operated only.
Hope i was easy to understand,
Please feel free to follow up whatever you want to ask or any confusions.
If you have any suggestions to make answers better feel free to suggest.
God bless you and Regards!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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