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What causes iver cirrhosis?

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Posted on Thu, 13 Mar 2014
Question: Hello, I am hoping you can provide some insight for me as I am really scared, and can't get my GI doctor to respond. Two weeks ago I had a contrast enhanced 3 phase CT of my abdomen. In January, I had a non-contrast CT that showed nodularity on my liver. Shortly afterwards, I developed mild URQ tenderness, and some nausea which is ongoing. The doctor I was referred to (and waited 6 weeks to see) also ordered an array of blood tests. I should also mention that I was diagnosed with fatty liver twelve years ago. Once the results were back, he had a nurse call me who referred me to two other physicians; one who specializes in Liver Transplantation, and Cirrhosis, and the other who can do an EUS on an enalrged lymph node near my pancreas. No opinion was given, just "call these other doctors." The specialist cannot see me for two months! Can you tell me based on the results below, if I am seriously ill? Do I need to see someone sooner? I realize cirrhosis is serious, but is there any indication how far along this is? Nothing like this showed up on a CT scan one year ago.Hoping for some peace of mind. AFP tumor marker, hepatitis were all negative. Comparison: CT scan 12/29/2013. Contrast: 80 cc Omnipaque 350 Technique: The exam was made precontrast and in 3 phases postcontrast. Findings: Limited visualization of lower chest: No pulmonary consolidation, pleural effusion or pneumothorax. Liver, gallbladder, spleen and pancreas: There is hepatic steatosis. Multiple small hepatic nodules identified, similar to the previous study. These show mildly increased attenuation relative to liver on precontrast imaging. No significant arterially enhancing nodule is detected. The nodules become nearly isodense on venous phase imaging. No rapid washout. There is mild irregularity of the ventral margin of the liver. The above findings may be compatible with cirrhosis. There is no clear enhancement of the umbilical vein to confirm recanalization although mild prominence is noted. Abdominal or pelvic adenopathy: Mild right upper quadrant adenopathy is again demonstrated, not clearly changed. The dominant node is peripancreatic and essentially stable, 14x25 mm compared to 17x28 mm previously. Other adjacent nodes also appear stable. Aorta and vascular: No aortic ectasia. Single left and duplicated right renal arteries. Typical hepatic arterial anatomy. Stomach, small bowel, colon and appendix: Colonic diverticulosis. Previous partial descending colectomy. IMPRESSION: Hepatic morphology and enhancement pattern most likely represents hepatic cirrhosis with a scattered regenerative/dysplastic nodules. The increased attenuation nodules on noncontrast imaging are likely siderotic. No abnormal enhancement to suggest HCC. While there is significant overlap between imaging appearance of benign hepatic nodules and well-differentiated HCC no focally suspicious lesion is identified.
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Answered by Dr. Klerida Shehu (1 hour later)
Brief Answer: Kindly upload your test reports... Detailed Answer: Hi, I have read your medical history and feel sorry for the situation you are in. Based on your medical history and ct-scan of December 2013, the very first thing is to find out what is causing cirrhosis to your liver; and then, to determine the nature of the swollen abdominal lymph-nodes. So, I recommend to run EUS (endoscopic ultrasound), during which, needle aspiration is used to get enough material for biopsy of lymph-nodes. Next, to determine the causes to your liver cirrhosis and damages occurred, I kindly ask to upload all the tests (blood tests, scan, ultrasound, and others) you did in order to get them evaluated and assisting you further. Thank you for your kind collaboration! Dr.Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Klerida Shehu (4 hours later)
Hello, I have uploaded reports, but cannot tell if all of them are attached. There should be a total of 21 items. Can you let me know if you received all of them? FYI, I seldom consume alcohol, and never to excess.
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Answered by Dr. Klerida Shehu (21 hours later)
Brief Answer: Possible auto-immune cirrhosis,EUS'll determine.. Detailed Answer: Hi again, Thank you for following up. I have read your medical reports carefully and noticed that the final impressions of CT-scan you did were liver cirrhosis. As long as there is no increased bilirubin (from your lab test reports) and not esophageal varices noticed, it is a compensated cirrhosis. With regards to the origin, I have noticed that ANA and anti-trypsine levels were high, indicating possible auto-immune origin for the cirrhosis. However, I still insist to do EUS (endoscopic-ultrasound) and to aspirate material for biopsy of lymph-nodes; which will also give a final diagnosis to your scan findings. Looking forward to have the EUS reports to further assist you! Dr.Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2266 Questions

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What causes iver cirrhosis?

Brief Answer: Kindly upload your test reports... Detailed Answer: Hi, I have read your medical history and feel sorry for the situation you are in. Based on your medical history and ct-scan of December 2013, the very first thing is to find out what is causing cirrhosis to your liver; and then, to determine the nature of the swollen abdominal lymph-nodes. So, I recommend to run EUS (endoscopic ultrasound), during which, needle aspiration is used to get enough material for biopsy of lymph-nodes. Next, to determine the causes to your liver cirrhosis and damages occurred, I kindly ask to upload all the tests (blood tests, scan, ultrasound, and others) you did in order to get them evaluated and assisting you further. Thank you for your kind collaboration! Dr.Klerida