US wording for cirrhosis

[Margolia]

Dear all: I have a question to people who have had their US done and were diagnosed with cirrhosis. I am confused as mine says - mild-to-moderate hepatomegaly, echogenicity is wnl, no significant steatosis, mild surface nodularity in keeping with chronic liver disease. One doctor ruled out cirrhosis, the other one said early stage cirrhosis. I am confused now. I am not looking for the diagnosis here of course, just to see what wording is used by radiologists in these situations. I have no idea what are my next steps? Go ahead and insist on seeing another doctor? I just want to be sure about what I have. Ask for biopsy? They were not willing to refer me. ((? Thank you for reading! P.S. 5 months before this US, I had CT scan done and it showed only mild-moderate steatosis. Now - no significant steatosis but mild nodularity (((( I am scared of some kind of aggressive form of fibrosis which developed in such a short time frame into cirrhosis? (((( If it is so, I need to do something. I am not panicking, just trying to avoid situation when it is too late to do anything.

[Kristian]

Ok Margolia, now breath.

Right, firstly there are elements of your US that are a great help to confirming a diagnosis and actually should be quite reassuring.

They can clearly see that there is some ongoing liver disease present due to the surface texture changes and the mild to moderate enlargement of the liver (Hepatomegaly -posh name for an enlarged liver). If they felt that the textural changes were reflective of cirrhosis they would normally highlight this in the report, they certainly used to on mine, although your own consultant would make the final determination.

"Echogenicity wnl" I'm guessing means Within Normal Limits. So again quite positive. If there was a lot of scarring present then the echogenicity would be different. I think its increased with scaring but I may have that the wrong way round and it may be decreased. Either way, yours is normal so 👍. It doesn't completely rule out there being no fibrosis present. But, if there is, its less likely to be too far advanced.

Ultrasound is good for picking up signs of fat in the liver, so again take it as positive that the report is highlighting that there are no signs of steatosis. It doesn't mean to say there is no fat present, but if there is its not got to that steatosis stage. The fact they haven't referred to fatty deposits can also be quite reassuring. If they were present then that would be included in the report.

Your original consultant indicated that you may have some early stage cirrhosis. Based on this ultrasound they may take another view on that and I wouldn't be surprised if they moved away from that diagnosis. Fibrosis can sometimes be referred to as early stage cirrhosis so there can be a little bit of confusion in that and its not that helpful a classification. Now your consultant has this ultrasound as well as your other scan he or she will be in a better position to determine a diagnosis. But, it still may be a bit of a mystery if there isn't an obvious cause. They may still indicate that some fibrosis may be present just to err on the side of caution too.

Clearly there are still some mysteries to solve in your case. Doctors like mysteries as they make you interesting, lol. I'm therefore sure that your own doctor will happily discuss these results with you to give you a bit more of a propper explanation that is directly relevant to you. Afterall they'll have all your other test results to draw on too.

I dont think there is any need to change docs just yet. Diagnosing liver disease can be a bit of a moving feast. So dont get too concerned if they possible causes change over time. Mine certainly did, lol.

You mention pushing for a biopsy. By all means ask your doc about this, but you'll find they are quite reluctant to do them these days as other imaging modes can usually give enough info to avoid invasive practices such as biopsies. Biopsies carry risks so if they can avoid doing them they will. Again this is pretty normal practice in my experience.

Hope thats helpful.

[Margolia in reply to Kristian]

Thank you for taking your time for such a detailed answer. The hepatologist that I had consultation with has discharged me with good prognosis right after our first appointment. She just said to avoid alcohol and try to keep the 2,000 mg diet. I asked my family doctor to refer me to another hepatologist. He refused at first saying that based on my history (I am with him for the past 20 years), I do not have a cirrhosis. I insisted and he referred me. It will take up to half a year to get this second opinion consultation. I am still deciding whether to push it if I can or wait. Meanwhile, I wrote to my first hepatologist (who discarged me) and said that I need more information and follow up from her. She agreed to have a phone appointment at the end of September and sent me to another US (just learnt about it) to be done before this appointment. I am doing my blood work on a monthly basis - in June she has put this requisition on auto renewal for the next year.

I just need to understand what is wrong with my liver and what is also important, I need my diagnosis to be correct in my chart. If it is cirrhosis, I am fine with it, as nothing is going to change in my lifestyle anyway whether it is cirrhosis or fibrosis - it will just add US each 6 months to my routine which I was willing to have even when I had no disease.

I don't like being in limbo; I am not stressing out but it does annoy me. In 2010, I was in clinical deaths for 2 times one after another, in induced coma with multiorgan failure. I woke up with my ribs broken, tube in my nose through which I was going to be fed and not functioning kidneys (liver came back at that point) and was told that most probably I will be on the dialysis 3 times per week indefinitely. I also had a foot drop and was preparing to have a cane as my permanent walking aid. I recovered, so I can say that I have at least touched the beast. It is just that I need to know what I am dealing with. I am not sure why doctors are making it so hard for the patients. I am currently in Canada and I wish I could pay for the consultation but I can't even if I am willing to pay to speed up the process. Meanwhile, I am trying to get bits of information from everywhere I can. Thank you for reading and helping. 🙂

[idyllic420]

Hello! I hope that you are keeping well and taking care of yourself after your recent diagnosis. If I was you then I will def push for a more accurate diagnosis and understand what caused it...also completely understand the path going forward. May I ask you about your brif history with alcohol? Did you continue to drink after your CT scan? Just trying to understand the events a bit better that probably led you down here and hopefully not probing too much. Take care!

[Margolia in reply to idyllic420]

Hello, thank you for response. Yes, I really need an accurate diagnosis. When the hepatologist discharged me with the diagnosis, she mentioned that they have an early cirrhosis clinic but refused to refer me as I am not eligible (why mentioning it at first place if I am not their candidate). She also refused to refer me to gastroscopy as she saw no need. I am confused. I was able to set up a tele-appointment with her in late Sept. to clear things up. I will have my second US done in 3 weeks. To answer your question, I have not changed my drinking habits after the CT scan last year. I can say that I was drinking more than I should, however, I have never had issues with alcohol affecting any aspects of my life and was never was diagnosed with an alcohol addiction (I do not smoke or use drugs). When chronic liver disease was mentioned (let alone cirrhosis), I of course removed alcohol from my menu which is fine. However, I do have problems with salt but that is fine, I am gradually working on it. It is hard to force some food down with no salt on it. I can live without sugar but salt has always been an issue. 😿

[Onesmallstep1969]

Hi,

A normal healthy liver appears smooth on Ultrasound, with no apparent rough texture or nodularity. The edges are smooth also. The echotexture is described as "homogeneous "while a cirrhotic liver often is described as "heterogeneous". The echogenecity of a normal liver is "hyperechogenic". Other than that, the size is described as being within nomal limits or not. The spleen is also decsribed in size as being normal, since often cirrhosis is accompanied by changes in the size of the spleen (the spleen can become enlarged because, in some cases, it is sequestering platelets, which is one of several reasons platelets can be low in cirrhosis). The normal liver appears dull or just neutral. A fatty liver appears bright or shiny on an ultrasound. If your ultrasound was a Doppler ultrasound, it will also give you info on the speed at which blood is flowing through your portal trunk. Cirrhotic livers have slow speeds. I think the cut-off is 16 cm/s. Best of luck to you.

[Margolia]

Thank you very much for taking your time to respond. This is exactly what I was looking for. It has now been confirmed that I have severe fibrosis which will be treated as an early cirrhosis for cancer screening purposes which I am glad to do without the need to constantly ask for US test which may or may not be performed depending on GP mood. I am definitely not happy with the diagnosis but I have what I have, so this is just one of the few positive things that I have gained from it. 🙂

[muffins7]

Hi Margolia, did you have a drop in platelets with severe fibrosis?

[Margolia]

Hi: I have had a severe drop down in platelets, hemoglobin, albumin when I had acute hepatitis which warranted blood transfusion. Once I recovered, the blood count stabilized at wnl levels. So even though I have the fibrosis, at this point of time it doesn't affect my blood test results.