Elastography or a fibroscan of the spleen

[Fibro2021]

Hello everyone.

I wanted to know if anyone had an elastography or a fibroscan of the spleen together with the liver and what were the results?

[Motik]

Spleen fibroscan/elastography should be standard procedure when suspected diffuse or vascular liver process. I had 5 elastographs and several fibroscans focused only on the liver. People with non-cirrhotic liver pathologies are doomed in current orthodox medicine. There are several people among us in the forum affected by non-cirrhotic liver diseases. Thanks God for keeping us alive, because we cant relay on our ignorant liver "specialists"..

[Fibro2021 in reply to Motik]

Thanks for your reply, Motik. I would like to say that spleen Fibroscan / elastography should become a standard procedure in liver Fibroscan / elastography. In recent years, medical articles (for example here link.springer.com/article/1... have appeared on the advisability of spleen Fibroscan for the selection of patients with suspected portal hypertension in the absence of liver cirrhosis (non-cirrhotic portal hypertension (NCPH)), since the normal size of the portal vein and the normal size of the spleen do not exclude portal hypertension. It is believed that in such situation, the density of the spleen is much higher than the density of the liver (normally they are approximately the same).

In my case, the elastography of the liver showed 7.8 kPa, and the density of the spleen was 19.5 kPa. In laparoscopy the surface of the liver is nodular and on histological examination nodular regenerative hyperplasia (NRH) and non-cirrhotic portal hypertension (NCPH) were diagnosed. Now I'm worried about severe weakness, lack of sleep, nausea and lack of appetite, ringing in the head, weight and muscle loss, fetor hepaticus and musty body odor. The skin has become thin and stretched like a gum. Rifaximin and lactulose do not help me.

[Motik in reply to Fibro2021]

Maybe you should try Hepa-Merz if you have a way to gather it. Im telling you, first month after my disease started to get serious the only thing manage to fix my severe weakness was Hepa-Merz.

Regarding the other things, my laparoscopy biopsy was refused because according to the doctor it was not so informative as the truecut. In the truecut the tissue peace was bigger and included more portal spaces or something like this.

[Fibro2021 in reply to Motik]

Thanks for the advice! It is strange that the doctor said so about laparoscopic biopsy, as it is considered more informative in non-cirrhotic diffuse liver diseases and it is possible to obtain a tissue sample from the right place under visual control of the size that is necessary for correct interpretation. By the way, with laparoscopy, they can take samples from several places and a needle biopsy is also possible. But in general you are right. Orthodox medicine has turned face to cirrhosis and back to everything else. Judging by the numerous answers to my question, there is a big problem with spleen elastography.

[Motik in reply to Fibro2021]

I did some research and it seems that splenic elastography and thromboelastography are quite used recently to diagnose liver pathologies. And I think this forum is the right place for this discussion. Large community with many competent members. Over the last few months, I have received a lot of useful information and I have met many great people who have expressed their first-hand opinions and given their support finding my undiagnosed liver disease. thank you guys. Special thanks to you Fibro2021. If you have anything else to add I will be glad to read it.

[Fibro2021 in reply to Motik]

I just wanted to add that non-cirrhotic portal hypertension (NCPH) is very difficult to diagnose, especially with a normal size of the portal vein and spleen, and since the LFT changes little or even within the normal range. Elastography / fibroscan of the spleen together with the liver makes it possible to suspect this disease in patients who do not have cirrhosis according to other examinations. This is very important, as there is no transformation in cirrhosis with NCPH, but although the end stage of liver failure with the development of hepatic coma or fatal varix bleeding may be present.

[Alibaba80 in reply to Motik]

What have you been diagnosed with Motik? I am so so unwell with Nodular Regenerative Hyperplasia and the drs just wont believe or understand how ill I am. I had to fight for a liver biopsy.

[Motik in reply to Alibaba80]

No official diagnose yet, most likely I have something similar to yours, but as Fibro2021 said its difficult to diagnose. I did my second biopsy last week, now I'm waiting for results. I hope to get some closure diagnose... Its been almost 9 months since the clinical manifestations first appeared. You can see my previous posts.. its all there..

[Alibaba80 in reply to Motik]

Yes the so called specialists are totally ignorant and think I am exaggerating. I have never been so unwell in my life and dont understand how I can be so ill and it now show more obviously...

[Motik in reply to Alibaba80]

Since when are you in this condition?

[Alibaba80 in reply to Motik]

I have had symptoms on and off for a couple of years but always recovered but now I have had these chronic and very severe symptoms for the last 5 months. How about you?

[Amethyst91]

Can I ask what made your dr do this biopsy when your results were ok? Was it the fibroscan of the liver and spleen?

[Fibro2021 in reply to Amethyst91]

It was just that the doc was evaluating not only my biochemistry data, but also my complaints and long history of alcohol abuse. He was well informed about the problems of finding small- nodular cirrhosis and liver diseases that linked with non-cirrhotic portal hypertension. It was liver and spleen elastography, to be precise.

[Amethyst91]

I’ve seen 3 major Hepatologists in the last year who don’t seem to care about my alcohol history. My spleen is at upper limits but not enlarged as well as my liver being 20cm but they say it’s just an extra long anatomical variant. I had hollow point needle buoy that only showed mild bile pigment. Kpa last year 3.8 but I have so many symptoms that I feel are more sinister and constant URQ pains and never feel well anymore. I’m only 30 and wonder if anything is missed

[TT-2018 in reply to Amethyst91]

3 major Heptologists and a fibroscan score of 3.8, plus a liver biopsy that gave you the all clear.

At some point you need to accept that whatever issues you have are not liver related.

[Fibro2021 in reply to Amethyst91]

I read that the diameter of your portal vein is enlarged. Have you measured the linear speed of blood flow in the portal system with Doppler (portal, splenic and superior mesenteric veins)? What specific symptoms are you currently concerned about?

[Amethyst91 in reply to Fibro2021]

I have had Doppler ultrasound and fibroscan if that’s what measures that.

[Fibro2021 in reply to Amethyst91]

With the enlargement of the portal vein, which you wrote about, they probably ruled out portal hypertension, probably non-cirrhotic (if they considered this version), since your fibroscan data is in the normal range and shows the absence of cirrhosis. As far as I have read, Gilbert's syndrome does not lead to an increase in the diameter of the portal vein. I also have Gs confirmed by a genetic test.

[Amethyst91 in reply to Fibro2021]

I know GS isn’t supposed to cause anything. I wonder if it’s why I itch and have pale stools though.

[Fibro2021 in reply to Amethyst91]

I also have pale stools and sometimes itching, but my symptoms are associated with liver failure linked non-cirrhotic portal hypertension and NRH. Your symptoms should be assessed by your doctor, as well as the reason for the enlarged portal vein.

[Amethyst91 in reply to Fibro2021]

I should be satisfied with my tests but I just know something isn’t right.

[Fibro2021 in reply to Amethyst91]

Many doctors and even hepatologists told me the same thing.

[Amethyst91 in reply to Fibro2021]

But your biopsy finally found something didnt it?

[Fibro2021 in reply to Amethyst91]

Yes that's right. The needle biopsy was questionable and they did a biopsy at laparoscopy.

[Amethyst91 in reply to Fibro2021]

What did the needle one say initially?

[Fibro2021 in reply to Amethyst91]

According to the conclusion of the first pathologist, morphological changes with signs of intracellular cholestasis and vacuolar dystrophy of hepatocytes, although another pathologist who re-evaluated the same material already found in it signs of nodular regenerative hyperplasia of the liver and non-cirrhotic portal hypertension. So the assessment of histology is probably still influenced by the training and qualifications of the hepatopathologist, especially in non-cirrhotic liver diseases.

[Amethyst91 in reply to Fibro2021]

Did you go through a transplant hospital for your biopsy or was it a regular GI office that ordered the test?

[Fibro2021 in reply to Amethyst91]

It was a local transplant center.

[Amethyst91]

I’ve had many tests but I’m not sure if they measured the pressure. When I ask about it they tell me mine is just naturally larger like my liver. I’m fatigued all the time, constant dull URQ pain that goes to my neck and shoulder blade and also stretches to my right hip, red palms, itchy all over, sometimes get random rashes, twitching in the gallbladder area, sore hand and feet. It’s really the URQ pains that send me back to the dr.

My AST is 25 and my ALT is 16, bilirubin is always at boarder of 1.2 or higher at 1.6 but they genetically tested me for Gilbert’s syndrome and I’m positive.

My MCV has never been high before but last month it was 96.6.

All my drs tell me I’m as healthy as can be and that I’ve had more testing done than most ppl with liver disease and I agree in that but my symptoms just don’t add up to being healthy or just having IBS

[Alibaba80 in reply to Amethyst91]

What are your symptoms hun?

[Fibro2021]

One of the most recent published articles about Identifying Patients at High Risk of Developing Non-Cirrhotic Portal Hypertension is available here dovepress.com/identifying-p...

[MINTVCX]

Very interesting subject. Do you know some studies how common NCPH is?

And what is the mechanism of liver failure sometimes without actual fibrosis of it? Is it known?

As I undestand Non-Cirrhotic liver disease is diagnosed by ruling out cirrhosis? And mostly based on symptoms? Am I right?

[Fibro2021 in reply to MINTVCX]

There have been no systematic studies of the prevalence NRH in the population and most reports in the medical literature are based on the description of isolated cases. The only retrospective study to find out the frequency of its occurrence in the population showed that the prevalence of NRH was 2.6%. In 10.2% of cases, various degrees of nodular formations were diagnosedNRH is associated with a variety of conditions such as viral hepatitis, drugs, contraceptive medications, anabolic steroids, antiretroviral therapy and HIV, systemic diseases, autoimmune thyroiditis, hyperthyroidism, celiac disease and many other conditions.

As you can see from the article, now no condition leading to cirrhosis can be an exception for the diagnosis of porto-sinusoidal vascular liver disease (PSVD), including alcoholic related liver disease (ARLD), which can lead to phlebosclerosis of the portal venules and sinusoidal obstruction. Presumably the indications for liver biopsy for PSVD diagnosis should be expanded according to the latest recommendations of VALDIG (Vascular Liver Disease Group) experts and the pathologist must be well trained and actively look for signs of this condition. It's also necessary to apply a special staining of histological samples (reticulin stain).

Liver failure is most likely linked with shunting of blood bypassing hepatocytes through many paraportal shunting vessels in the liver (in this regard, it's possible to see an accelerated linear blood flow speed with Doppler examination of the portal, superior mesenteric and splenic veins). Synthetic liver function is generally preserved and LFT are normal ranges as a rule.

[MINTVCX in reply to Fibro2021]

I see thank you. Are present any option for the treatment currently ? I do not know maybe some stent to keep the passageway open?

[Fibro2021 in reply to MINTVCX]

The main problem is shunting blood past the liver functional tissue. Intestinal toxins poison the body and brain, leading to HE. If large shunts are found on CT or ultrasound, they may be surgically occluded. If large shunts are not found, then the only treatment is orthotopic liver transplantation. Typically, patients with NRH have lower MELD (UKELD) scores than patients with cirrhosis despite the severity of the condition and this is a serious medical problem. If there is a risk of variceal bleeding and no persistent hepatic encephalopathy, then consider TIPS as a treatment option, but this can lead to increased risk of HE.

[MINTVCX]

Just wonder were you diagnosed with Gilbert's Syndrome during you started your symptoms? I

[Fibro2021 in reply to MINTVCX]

These are not symptoms of Gilbert's syndrome. I did a genetic test for GS due to a mild increase in bilirubin. Gilbert's syndrome is just an unfavorable background, in my opinion, against this background liver damage can develop faster or to a greater extent than in its absence. I never had any problems with this condition and didn't even know about it before the manifestation of symptoms of liver failure

[MINTVCX in reply to Fibro2021]

Yep I know never blame GS according to science. There are some positive aspects of slightly higher bilirubin on heart for example.

On the other hand there is no evidence of any negative impact on liver although some hepatologists say it is not helping. I think too many people have it and some negative aspects would be already seen. But this my guessing only although I have GS myself and some indications of liver problem but nothing conclusive so far.

[Fibro2021 in reply to MINTVCX]

Have you ever heard of the "survivorship bias"? This is a systematic selection bias by the researcher. I think the situation with the diagnosis of NRH fits very well with this concept.W

With regard to Gilbert's syndrome, the detoxification function (glucoronyltransferrase activity) of the liver is reduced to 30% of the normal level, and under normal conditions this is quite enough for a normal life.

[MINTVCX in reply to Fibro2021]

Yes I know it the bilirubin level with GS is not harmful if not other factors.

I wonder if alcohol can damage liver faster when someone has GS. But see this article which is quite different. But this is only one study and not directly checking this.

"Gilbert's syndrome and the risk of death: a population-based cohort study"

"Conclusions: Mortality rates observed for people with Gilbert's syndrome in the general population are almost half those of people without evidence of Gilbert's syndrome."

pubmed.ncbi.nlm.nih.gov/237...

[Fibro2021 in reply to MINTVCX]

Sometimes it is very difficult to fit a particular patient into the Procrustean bed of statistical data.

[MINTVCX in reply to Fibro2021]

That's true.

[Oztrax]

Fibro2021,

You are a wealth of information 🙃

And like myself a very analytical person.

I believe now I may indeed have NRH.

Here in Australia, we have pretty good health care, my family doctor can order blood tests,ct,us with no cost .

MRIs have to be authorized by specialists.

Also the public hospital system is pretty good, I only waited 3 weeks to have a follow up colonoscopy.

I have online access to my ct scans and us, which I have studied in detail.

Last month US has “hepatopetal: velocity A 27.7 cm/s”

Assuming this is portal vein flow, “portal vein was not well evaluated on this study “ so I don’t have a measurement.

“Spleen unremarkable common multiple granulomata are demonstrated “

2019 US has portal vein at 8.2 mm diameter.

I have fibroscan booked for 21st april , seeing my family doctor (called GP here: General Practitioner ) on the 11 th April to discuss advanced liver tests , iron copper studies etc.

I think I should ask for spleen fibroscan as well.

I have been on Leflunomide/Arava for 10 years for pretty severe Psoriatic Arthritis which has destroyed a number of finger and toe joints.

Arava is a DMARD so it’s possible it may be causing NRH.

We’re you able to discern if medication led to your NRH ?

Regards

OZ