Liver biopsy

[Linakes]

I wonder how to persuade my doctor to take liver biopsy?

[aranshaw]

By getting another test that indicates liver cirrhosis but leaves an element of doubt, such a bloods or ultrasound.

[Kristian]

With great difficulty, even when it was clear some liver disease was present, they are generally reluctant to do a biopsy. As less invasive and risky options are available a biopsy would be the last resort. There were need to be significant evidence of disease to warrant the procedure. Again even then it may not be diagnostic unless damage is widespread or they got lucky. The samples taken are very small, so could easily miss anything that wasn't widespread.

[Linakes in reply to Kristian]

I know that there is a pretty high chance of false negative, but I just don't know what else to do. My ELF test was 8.3 which can mean that i have moderate fibrosis. Maybe this can help to get biopsy. I have had several elatographys, all within normal range. But on this site I read about many people who have normal kpa, but have obvious symptoms of liver desease, so i lost trust in elastography completely. I had a very thorough ultrasound from a very good doctor, he examined my liver for like a half an hour and said everything is ok. But there are some ct and mri findings (I have flash with pictures) that point to cirrhosis, but doctors seems to overlook it. It sees its impossible to get diagnosis until you get decompensated..I was hospitalized and had extremly low vitamin D, low folat and borderline b12 (296). Thats what people with cirrhosis has. But i have to mention that it happened after 4 months of deep depression, constant stress mode, almost never going outside and very poor diet. So maybe that contributed to that. And I live in Norway, there is not so much sun here.

[Kristian in reply to Linakes]

Cirrhosis on ultrasound is usually pretty obvious. It leads to quite a marked change on surface texture and organ size generally. So if your rather good doctor said it was generally OK it would be highly unlikely it would be anything different. Low vit D foliate etc are not specific to liver disease. As you recognise yourself, not getting too much sunlight is usually the most common cause of Low vit D. I think in the uk quite a high proportion of the healthy population have low vit D, lol.

[Linakes in reply to Kristian]

But ELF score 8.3 worries me

[Belleben in reply to Linakes]

Do you have any other signs? Things like jaundice, yellow eyes etc. Do you have dark poo?? Are you itchy & really need to scratch. Do you have any thread veins or liver spots which are red in colour. How do you actually feel in yourself ????

[Linakes in reply to Belleben]

I dont have any of that, but such things come with very advanced cirrhosis.

[Linakes in reply to Linakes]

I am worried because my ELF score was 8.3. I am planning to fo another one in july to see

[hells456 in reply to Linakes]

No, on this site you have read lots of people with health anxiety who have convinced themselves they have serious liver disease. They have a load of non-specific symptoms and disbelieve their doctors and tests. Liver disease is often missed because there aren't any symptoms until fairly advanced, but is very easily found if looked for. It would show up in blood tests, ultrasound or fibroscan. Generally it is quite easy to get false high results, such as eating before a fibroscan, inflammation from a bug, taking painkillers affecting blood tests, etc. It's very difficult to get a false low result.

[Belleben in reply to Linakes]

What was your vitamin D score

[Linakes in reply to Belleben]

12, (in Norway normale range is considered 50-12o) which is severe deficiency. But like i said it was after 4 months of deep depression, chronic stress and very poor diet. I was on sick leave and barely went out. There is not much sun in Norway anyway. After supplements it came up to 77

[MINTVCX in reply to Linakes]

What unit? Normal is usually 30-50 ng/ml so 75-125 nmol/L.

[Linakes in reply to MINTVCX]

Not sure. But it was severe deficiency. But after supplements its fine now.

[Dramalady in reply to Linakes]

Hi. Sorry you’ve been unwell.

I would trust the numerous Fibroscans you’ve had. They are pretty accurate at ruling out significant fibrosis. A thorough review with a doctor is also very reassuring. There are studies on the ELF test that show people with normal livers having an ELF test in that range.

I was totally fixated and worried when I had high fibroscans and then an ELF of 8.

My liver specialist however, said that it was debatable whether I had any fibrosis (despite ELF 8) at all as my bloods had always been normal along with ultrasound, CT and MRI.

I somatised symptoms and was in a constant state of anxiety but ultimately I was healthy. I stopped drinking alcohol. My repeat ELF five years later showed fibrosis regression to a normal 7.3. Just as the doctor had predicted.

Trust the doctors if you’ve had the numerous tests you’ve. They see liver disease all day, every day. They don’t let any ambiguous results go unchecked.

[Livmar]

Get an MRE if you are able to. They are far more accurate than Elastography, fibroscans etc. It will tell you percentage of fat and overall cirrhosis. Best of luck🙏

[Linakes in reply to Livmar]

You mean magnetic resonance elastography?We dont have it in Norway. I would fly to another country if there was a possibility, but i dont know where they do it and if its possible just to order that.

[Linakes in reply to Livmar]

I tried to reasearch, but it seems that the only country that offers private mre elsatography is USA?

[Bikafella]

You do seem very concerned about your blood results (which is not unreasonable) but are you suffering from liver disease symptoms? If your doctor says you're ok and you don't trust him/her then you need to examine your own reasons as to why that is. As Hels456 said many people here are over worried for no reason and won't believe qualified medical practitioners. Personally, I pay no attention to blood test results as interpretation is complex. If you feel OK and the results are out of the ordinary then the doctors will know what to do, but you may have to learn to live without worrying about blood test results.

[Yellowsydney]

Biopsy is usually the last resort, it is an invasive procedure that can cause more problems, excess bleeding. I had two, I had variceal bleeding but no other symptoms, bloods normal, ultrasound and CT scan didn't show anything, even the 2 biopsy were inconclusive it was just down to gut instinct of my consultant, although we can find no evidence you must have NASH cirrhosis. This went on for 7 years before bloods suddenly declined and I was put, I was put on the transplant list, I still didn't believe then as I didn't feel ill. Trust in your doctors, they will perform whatever tests they think necessary, if you don't need a biopsy all the better with the risks involved.

[kensimmons]

Don't get a biopsy. Go take a two or three week vacation in Isreal, Jordan (Dead Sea) or Turkey, get at least 30 minutes of sun each day (if you can handle it) and your D levels will soar up. Only problem is many of those places have many Russians right now who are escaping being called up to active duty. So maybe Florida in the USA. Just get some sun in the summer. It's important to do so.

[Linakes]

Thank you for your answer.

[sophiaS1980]

Check your platelet count on your labs, if they are high normal then don't worry so much, most ppl with liver disease about 85% will have low platelets.

[Linakes in reply to sophiaS1980]

What is high normal range?

[sophiaS1980 in reply to Linakes]

Look at your labs, it gives a range, every lab is different , i don't know your range for your labs.

[Corin1950]

I had an ELF test of 9.8 indicating possibility of significant fibrosis so was sent for a fibroscan but got results of 4.3 kPa which is no fibrosis and CAP of 270 indicating fatty liver.

[Readlots]

You don’t want a biopsy and you don’t want to be diagnosed with liver disease. There are lots of people on here with a diagnosis of liver disease who would love to have a doctor tell them they don’t need a biopsy. Take the win and focus on the positive.

You can do all the things that will protect your liver and make you feel better without having liver disease and definitely without a biopsy: don’t drink alcohol, eat healthily and excercise. I hope you feel better soon

[Linakes in reply to Readlots]

Thank you.