First appointment

When I had my gallbladder removed the surgeon said he thinks I have early cirrhosis, that my liver was scared and hard, so tomorrow I have my first specialist appointment. I don't drink (20 odd years ago I did at uni but very rarely since, as I seem to always drive). I get very tried all the time have water attention my bloods in April were fine just high RBC and low vitamin D but live fine. What should I expect from the specialist? What tests should I have?

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  • My guess is the specialist will look at the results he/she has and go through with you the possible diagnoses and how he will go about narrowing those down. He may even have a specific diagnosis in his head from the information he has. Expect loads of blood tests - they will be mainly to rule things out. You may well be referred for an ultrasound and an MRI. If the hospital has the equipment they may do a Fibroscan which measures how 'elastic' your liver is - it gives them a good idea of damage. He may mention a biopsy as well. Don't be frightened by that - it is the only way to diagnose certain things. But he may decide that isn't needed at this stage.

  • I would hope your specialist is one who is knowledgable about liver problems. I would push to have a full range of blood tests for liver function and also ultrasound and ct scans.

  • In addition I would also ask for an mri scan. This gives detailed information regarding you internal organs.

  • Thank you for your help, he did a full set of bloods that cover everything he could think of that affects the liver from Iron and copper right up to HIV also he thinks that i may have got the scarring from medical medication given.

    A couple of years ago i had treatment for latent TB (a course of injections) and i did not realise it as they had to give me auto immune suppressant medication for planter palmer psoriasis and arthritics. He said that the photos of my liver does show scaring but to what extent he does not know and said that he is not yet going to call it cirrhosis until he knows more. I have to wait to get the results of the blood test back and see him in 2 months time unless my blood tests show a problem. i thought that scarring of the liver even if slight is early cirrhosis as its scarred? Is that right? When he was talking to me about Cirrhosis he was explaining when you start getting problems when the liver becomes small and hard.

  • There is a sort of damage spectrum - so there is fibrosis (with several stages) and then cirrhosis. So perhaps he means that he thinks you have fibrosis? The big difference is that fibrosis can be reversible whereas cirrhosis can't. With many liver problems they can halt the damage even if they can't reverse it and the liver continues to function fine.

  • The liver has the ability to regenerate. As it experiences damage it inflames and then becomes scarred. The process of scarring is called fibrosis and there are several stages of fibrosis culminating in stage 4 fibrosis which is also called cirrhosis - where almost the entire liver has been scarred - at this stage regeneration is difficult or not possible and there may not be enough healthy liver tissue to carry on normally. A person can function normally with 10% of their normal liver tissue.

    It's not uncommon for people in the UK - including Doctors - to use the word cirrhosis to refer to the process of fibrosis (even if it is early fibrosis and very treatable). Even with cirrhosis if the cause of the damage to the liver can be stopped the prospects can be quite good. Cirrhosis and Fibrosis refer to the amount of scarring though not the process.

    So at this stage you need to get a clearer idea of the degree of fibrosis and the cause before you can work out what to do next. Hopefully - and I'll keep my fingers crossed for you - the fibrosis is not severe and cthe cause can be stopped or has passed.

  • PS - so far what he's saying sounds ok but you should get the blood test back sooner as they will raise alarm bells if you need to see him before 2 months so I would ask for those.

  • Thank you for the information, I am not as worried as I was. I will phone the hospital in a weeks time and try and get the results. If it was the medication it means that my liver has been scarred for at least two and a half years now.

  • Hi sharon7

    Several of the responses you have received mention there are various stages of fibrosis so just in case you may wish to know it there is more than one Scoring System that can be used to categorize those stages. Some do regard stage 4 as most likely being cirrhosis but the 'Ishak Scoring System' which I understand was used for the analysis of the biopsy I had upon my own initial diagnosis at my local hospital includes two additional pointers. On this System stage 4 is scarring that forms 'bridges' between blood vessels with stage 5 being extensive scarring / possible cirrhosis, and then 6 as cirrhosis.

    I recall I did lots of research at the time to find out the reasons for this but can not recall what they were.

    Anyhow thought it was some additional information you may like to have just in case it may help you to better understand what advice and guidance your doctors and specialists are providing you with and of course they are the best people to do that.

    Regards

  • Glad someone mentioned the Ishak score - just discovered it myself and came here to add a correction. Thanks.

    Anyway best of luck.

  • Thanks. Was just wondering as i haven't got the results yet from my blood tests yet, if the scarring is from medication taken 2 and an half years ago, how long does the liver take to heal? shouldn't it be healed by now?

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