Liver steatosis and cirrhosis

[Linakes]

Can you have liver steatosis and fibrosis/cirrhosis at the same time?

[Iro1]

I have both steatosis and cirrhosis on my record. This might be somewhat misleading though as I have an amazing 85 conditions on my GP record!The cirrhosis is from november 2019 the steatosis or fatty liver from feb 2022. This was the result of a us scan for a gallbladder condition no mention of change in size of the liver, simply echogenecity I asked the nurse at the time 'is the surface of the liver smooth?

as a baby's bottom was the response. I also checked about the width of the portal 'normal', I also CT two scans with dye, this shows up blood flow in the portal and around it no evidemce of varices.

Sent away in August 2020 with a comment was on cusp of cirrhosis liver but now stabilised now and told to come back in three years.

I am not a medical practitioner so do not really know but it seems to me the transition from NALD (steatosis) to NASH then fibrosis them cirrhosis is not fully understood.

I take comfort from the fact that a Senior Liver consultant has decided I do not need 6 month check, that a us scan has shown only steatosis nothing else, that my bloods are good and I feel well.

I have no doubt my liver will never be what it once was, I have not had a drink for over 4 years but that I will die with it rather than from it.

In a way it was lucky I got the gallbladder infection last year as i had the full suite of scans.

CT with dye in the blood, CT with dye pumped into gallbladder, a number of US scans net result 'steatosis' which is obvious to the untrained eye on the screen it is shiny with the fat refelcting the light.

[AyrshireK]

Yes, since steatosis is one issue that can lead to fibrosis and cirrhosis so there is bound to be a stage where the liver is both fatty and becoming fibrotic or even cirrhotic. I doubt it's ever just fatty or just fibrotic in a case where fatty liver liver disease is the cause of more advanced damage.

Fibroscan reports on fat content (CAP) as well as fibrosis score (kPa) so it can give two figures both of which may be normal or may indicate any degree of damage on the Steatosis scale S0-S3 and any degree of fibrosis on Metavir Scale F0-F4.

Katie

[Linakes in reply to AyrshireK]

I didnt have fibroscan, but 2D shear wave elastography with result <7kpa and mild steatosis. Radiologist said everything is ok, but google disagree with him. According to it i have at least some fibrosis, i even found a study with 4- 6 kpa indicating F2 fibrosis, so it's very confusing. I am planning to take a new scan (fibroscan), but i am not sure if it will clarify things since data on that varies a lot. Is it true thst F1 and F2 can be stopped?

[AyrshireK in reply to Linakes]

Anything up to even early cirrhosis is considered reversible. If diet and lifestyle are the cause then they need to be amended in order to see improvement.

[Linakes in reply to AyrshireK]

Even early cirrhosis?How do you know that?

[AyrshireK in reply to Linakes]

British Liver Trust page on cirrhosis britishlivertrust.org.uk/in... and I quote:-

"Reversing the Problem Until recently, it was thought that a liver with cirrhosis could not be healed. This is usually the case because most diseases that cause scarring of your liver (fibrosis) are long-term and difficult to ‘cure’. The treatment of Hepatitis B and C, as already mentioned, gives hope for the development of new drugs to combat scarring of the liver. More research, however, needs to be done before any new treatments become widely available."

Since you are not in that postition yet you are able to slow/stop progression and reverse the early stages of fibrosis.

"Making lifestyle changes and cutting alcohol out of your diet may help delay progression.

Many causes of liver disease can now be treated much more successfully than before to stop or at least slow down any decline in the condition of your liver.

This includes treating infections such as hepatitis B or C with new anti-viral medications and autoimmune diseases such as Autoimmune Hepatitis (AIH) with steroid-based drugs. Genetic Haemochromatosis (GH), an inherited liver disease, can be managed successfully with phlebotomy or venesection, a procedure similar to blood donation in which a quantity of blood is regularly taken from a vein in your arm."

[Linakes in reply to AyrshireK]

I find this table very confusing. Two different cut-offs, but both have similar NPV. According to this you can have cirrhosis if your liver stiffness is 5.62, which is as i understand average stiffness in healthy people. Read tons of articles and cut-offs differ quite a lot, but this one was quite extreme

[AyrshireK in reply to Linakes]

As far as I understand you can't compare results from a Sheerwave Elastography with those on a fibroscan. For every condition on Fibroscan a score of about 7 kPa represents at worse F1 fibrosis. Sorry, can't help with that chart you've got there - you've got to go with your own doctors interpretation of whatever tests they've run.

Katie

[Linakes in reply to AyrshireK]

I am worried that my CT showed slightly heterogenous enchancment and I read that you cant see fibrosis/early cirrhosis on CT, so that would mean I have advanced cirrhosis, even if elastography doesnt show that. So I am very confused.

[AyrshireK in reply to Linakes]

That's not true that fibrosis doesn't show on CT - maybe sometimes it doesn't but in some cases it will. You can't convince yourself that you have cirrhosis based on the fact your CT did show changes. If your doctors have said it's early fibrosis then that's where you are at. If you know the reason why you may have change in your liver you need to tackle that and hopefully you can stop any progression or reverse the fibrosity.

[Linakes in reply to AyrshireK]

Thank you for your answers. That CT scan really messes with my head.

[Linakes]

Mixed population. Thank you for explaining PPV.

[Linakes]

Like I wrote before that CT messed with my head, I got convinced I have advanced cirrhosis. But elastography wouldnt show < 7 pka if i had advanced cirrhosis?I hope so

[MINTVCX in reply to Linakes]

What was the reason for your CT? Any tests or symptoms to suspect liver disease? "slightly heterogeneous enhancement" is not enough to confirm liver fibrosis. The best is to see hepatologist.

[Linakes in reply to MINTVCX]

Intoxication. All "liver" tests are normal, but i sometimes feel tenderness on the right side of the abdomen.

[Fibro2021 in reply to Linakes]

The absence of liver fibrosis does not mean the absence of other liver diseases. Of course, the diagnosis of fibrosis is important, but it is more important to exclude the influence of all possible factors causing fibrosis, including toxic ones. Ranges and cutoffs are good for statistical research. For each individual patient, there will always be an element of doubt about the correctness of the interpretation of the obtained examination results. None of the examination methods is absolutely reliable. I think the best way is to continue to live a healthy lifestyle, eat right and hope that this will bring undoubted benefits to your liver as much as possible. Indeed, there is an opinion that as cirrhosis progresses, hepatic steatosis decreases, even if it leads to fibrosis and cirrhosis. But this is a general pattern so to speak. How much it will relate to a particular patient is very difficult to predict.

[Linakes]

Can elastography be used to rule out cirrhosis?

[Fibro2021 in reply to Linakes]

The sensitivity and specificity of elastography for the diagnosis of stage F4 (cirrhosis) is around 92%. In other words, 8 out of 100 patients (who have cirrhosis) who undergo elastography will miss this diagnosis.

[Linakes in reply to Fibro2021]

I doubt there is 100% sure method for diagnosing cirrhosis, even biopsy has its limitations, so 92% is pretty high.