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British Liver Trust
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Can cirrhosis be diagnosed without a biopsy and can fibrosis be much closer to cirrhosis if an US, CT scan and fibroscan all show fibrosis?

I guess my title sums you my question. Based on those 3 tests I was diagnosed with early stage fibrosis. I ask the question because I feel my symptoms were those of someone with more liver damage than early fibrosis.

I lost 10 lbs if water in the first week I was on Metformin. Prior to my diagnosis I was so full of water I looked like I'd burst. My stomach looked 8 months pregnant. I was always hot and sweaty when everyone else was freezing and I was so tired. I would be ready to dose off at traffic lights. My stool was pale and runny, my hair was falling out and my stomach was gassy and bloated. I always had reflux and belching and felt sick after I ate (did NOT lose my appetite or any weight).

It just seems like my symptoms were more like cirrhosis, especially my huge belly. And if it really is only as far as fibrosis how long does it take to heal? Obviously more than weeks, I still have the right sided pain under my ribs but most other symptoms have calmed down. And it's been almost 6 months. Does it take years to heal? And how will I know? And how will I know if it doesn't heal, if it's just a little better now from meds and diet but it's still get worse?

I know no one can say for sure, but I'm just wondering based on personal experience. Thanks.

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The symptom where your stomach was full of fluid sounds like ascites. You need a biopsy to determine the true state of your liver. Your liver may be in a stage of fibrosis before cirrhosis like you suspect but still able to repair itself with the ascites being a one-off event. Another possibility is that your liver is in an early stage of cirrhosis & if you do everything right you can live a normal life span. In your situation I'd want a biopsy so I'd know what I was dealing with.

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Hi

I can only speak from our personal experience as I have no medical background or knowledge. My husband was diagnosed with cirrhosis and indeed had a liver transplant at the end of last year. He never had a liver biopsy in the 5 years he was ill as he was terrified of having one!! Our consultant diagnosed by symptoms and CT scans. He had bleeding varices, ascites etc. One point was that in common with most other people we have met along the way he was always cold and could never get warm rather than the other way round.

Hope you start to feel better soon.

Kim xx

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I personally would try and avoid a liver biopsy, this should be a last resort option and should be done only if a herpetologist wants to see the structure of the liver. I personally regard this procedure as being an often unnecessary evasive procedure. There are plenty of other tests available. One of the newer blood tests currently being used is an ELF Test (Enhanced Liver Fibrosis). In some hospitals now, the pathology labs can use specific markers. These markers can identify fatty liver and Fibrosis, and is a good, cost effective way of identifying problems, and the need for further tests or scans.

A CT scan may highlight any tumours, and a MRI will help identify cirrhosis.

I hope this helps Lara, but I realise that there are going to be others who may want you to go straight for a biopsy. But this isn't normally necessary these days.

All the best (as always) Richard

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One of the reasons no-one can say for sure is that they don't know how long the liver has been assaulted for. If you do something repeatedly, let's say rowing, but incorrectly, it will damage muscles and eventually you will end up with chronic/ acute pain. If you then take steps to rectify this, massage, physio etc, the pain isn't going to go away with one or two treatments, it is probably going to take the same amount of time to dissipate as it took to get to a point where you couldn't tolerate it any more.

It is the same for the liver. If it's taken a long time to get scarred, it could take a long time to reverse some of the scarring, always supposing it's not permanent scarring. Equally well though, fibrosis can establish quickly if the disease is active.

I realise that this may be confusing (!), but this is part of the reason no-one person can give you a definitive answer. Results from the tests have to be taken together and build up a picture, like a jigsaw. Hopefully, you will get the answers you need from your doctor soon. All the very best :)

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My doctor didn't give me an answer. She told me there's no cure and she doesn't recommend a biopsy at this time. Based on the CT and US she seemed to doubt I had fibrosis but when she got the fibroscan back it was confirmed. She basically told me to follow the Mediterranean diet, don't drink and don't use supplements. She wants to see me back in 6 months.

The bloodwork she ordered in May was vastly improved from my previously results in February. That's after getting on Metformin and drastically changing in my diet immediately after my diagnosis. I'm concerned at this point because I'm feeling more pain below my rib then before. My doctor said there's no pain in the liver becuase there's no pain receptors. I'm sure that's true scientifically but I know what I feel.

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Apparently there’s a membrane around the liver that does have nerve endings and that’s what they think causes the pain

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The pain is from one of two sources and it is as your doctor said not originating from the liver. The liver is sealed with a fibrous capsule and it is this that has the pain receptors in it. This capsule will exhibit pain if the liver is exerting pressure on it. (as I understand what I have been told) Alternatively, the liver has enlarged and is pressing on surrounding organs and it is these organs that are causing the feeling of pain. If you look at how the organs are packed into the body, there really isn't much room for maneouvre. I know this doesn't help the pain, but maybe it will help explain why the doctor is telling you that the pain is not from the liver.

If your bloods are getting better, then this is a very good sign. With bloating, whether from gas or liquid, the best thing you can do is be very vigilant about trying to eat the same amount of food each week and keep an eye on your waistline, to see if it is getting bigger or smaller. This is from my own experience. If you keep to the same amount of food and drink, then at least any enlargement is down to gas or liquid. It is surprising how large the abdomen can get just from gas- again from my own experience.

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Here’s a question that’s puzzled me but I’ve never asked or looked up...

After a transplant is the liver still in a fibrous capsule?

Huw

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If you look at a chicken breast, it has a thin white film covering it, which I believe is similar to the capsule that would surround the liver. However, I am no doctor, so I don't know. It would seem likely that a liver that is removed from a donor would still have this capsule atttached- I see no reason for them removing it.

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I think your right about the capsule. And now im hungry for chicken lol

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Make sure it's organic!!! Don't want any of that stuff fed on antibiotics :)

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That's not easy to find in the USA and chicken is better than cows.

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Maybe you'll have to start rearing your own? How do you fancy looking after chickens lol :)

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Wellll if I didn't work 40hrs a week and live in a condo...

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Yeah- a few stumbling blocks there!!!! Foxes would probably get them first anyway :(

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