CAP score and kPa

[NorthLeedsJohnny]

Hi allCan anyone shed light on the following please?

I had a fibroscan in early May, following a series of irregular blood results. My GP described them as elevated but unremarkable.

In mid July, having chased the result for weeks, a doctor rang me to say that I would need to be treated as a patient with cirrhosis. She said the fibroscan result was a kPa of 49.6, F4.

A few days ago, I had a letter, confirming the phone call but with a bit more detail. As well as confirming a kPa score of 49.6, it gave a CAP score of 220.

Is it usual to have one very high and the other normal?

Im having an endoscopy soon, to check for varices and an ultrasound is due shortly too, before seeing them in clinic.

The doctor knows that the fibroscan procedure was difficult. The radiographers said that my ribs were very close together. It took a long time before they got a reading.

The whole process was a shock, as I very very rarely have any alcohol and that's always been the case.

I thought that, if there was any doubt, the fibroscan might be repeated but the consultant seems to be going in the direction of me having cirrhosis. The only symptoms I've had are feeling tired for a month or so and losing some weight.

Thanks in advance.

[AyrshireK]

Yes your kPa (liver density / fibrosis) score can be high and CAP ( fatty change) score normal. You can have fibrosis/cirrhosis without fatty liver AND you can also have cirrhosis with a zero alcohol lifestyle. There are numerous causes of cirrhosis - viral, auto immune, genetic, alcohol, non alcohol. Key things will be to definitively confirm your degree of fibrosis then start to work out the potential reason why you might have it and this will involve further tests.

Hope you get answers from your medical team soon.

Katie

[NorthLeedsJohnny in reply to AyrshireK]

Thanks Katie. Have you any idea whether having ribs close together could give a kPa higher than it actually is?

[NorthLeedsJohnny in reply to AyrshireK]

I have two autoimmune problems. Well, 1 current, coeliac disease and a former one lichen sclerosis.

Would the clinic try to establish whether this is due to a third, or simple deal with the current problem?

Thanks again.

[AyrshireK in reply to NorthLeedsJohnny]

No idea on the ribs issue as my hubby never had a fibroscan en-route to his cirrhosis diagnosis.

His was obvious by symptoms and on ultrasound scan. He's t-total and his issue has been autoimmune in nature - when you have autoimmune issues you often have more than one.

My hubby was always told he had cirrhosis secondary to Autoimmune Hepatitis (AIH) but subsequently to his liver being removed last month they are now thinking he may have had a second AI condition - Primary Sclerosing Cholangitis (PSC) in overlap with his AIH.A liver biopsy would usually be run in possible AI cases to establish which cells of the liver are being attacked - AIH attacks the hepatocytes whilst PSC and PBC (a 3rd auto immune condition which affects the liver) attack the bile ducts.

Katie

[NieceByMarriage]

If they have not already tested for auto immune hepatitis and viral hepatitis they may well want to do bloods for that. If they haven't tested for those things and don't mention doing so then, in your position, I would be asking them to. They can fairly easily exclude viral hepatitis or will do further tests if your blood has antibodies. I don't know about auto immune hepatitis but my blood was checked for that at the same time as for viral.

Lichen Planus can be associated with Hep C but I don't know about Lichen Sclerosus.

[NorthLeedsJohnny in reply to NieceByMarriage]

Thanks for that. My GP the other day, said that I was tested for Hep C in March, as part of my liver screening. It was negative.

[AyrshireK]

Ongoing liver inflammation could also potentially inflate your kPa score. Fibroscan can't tell the difference between actual fibrous tissue and inflamed tissue. Your score will need to be looked at in conjunction with your liver bloods.

[NorthLeedsJohnny in reply to AyrshireK]

Thanks ever so much. One thing I'm concerned about, is that the fibroscan was 2 May. The doctor rand me around 10 days ago. That was because I had pestered TV e hepatology secretaries quite a number of times. I do wonder if anything would have happened if I hadn't been so persistent!

[AyrshireK in reply to NorthLeedsJohnny]

You do end up having to be your own health care advocate these days. I have lost count of the number of times i've had to chase appointments, routine scans, routine bloods etc for my hubby. His consultant at Edinburgh has said she worries for patients like my hubby but "Who don't have a Katie!".

[NorthLeedsJohnny]

My experience too

[Pinkglitter93]

it does seem a very high Kpa. Is there any opportunity for you to get the scan repeated privately? I was told they do more measurements when done privately and had one recently. It’s awful you had to chase them with such a high score. I hope you get some answers soon.

[NorthLeedsJohnny in reply to Pinkglitter93]

I have wondered about that too. I'll look into it. Thanks for replying.

[mickeymouse42]

Have you had all the standard liver function tests? With those kpa levels you would expect some abnormalities. You could ask your GP for a FIB-4 test which is a blood test which a GP should be able to do routinely; it is a test for cirrhosis like the fibroscan but it can't measure fat content. If the FIB-4 result is normal then getting a repeat of a fibroscan would make sense.

[NorthLeedsJohnny]

Thanks for that. I'll check with the GP. I'm surprised the hospital haven't suggested that.

[TheTimer]

You need a biopsy. Fibroscan of 49 is very high. Biopsy should be next step then you will know. Surprised your medical team hasn't set you up for one.