PH & Blodd labs

[ToughToes]

Hi Everyone,

Does anybody know which blood tests, as in lliver enzymes and LFT's, might reflect portal hypertension and/or liver congestion?

Thanks in advance,

Terry

[ToughToes]

Anybody?

[gertrudestein in reply to ToughToes]

Hi ToughToes

When you posted 7 hours ago, we in Europe were, hopefully, sound asleep.

Only now are we waking up to read your posts which is why you are having to wait for replies!

[ToughToes in reply to gertrudestein]

Of course. I wasn't even thinking about that.

[AyrshireK]

Portal hypertension can't be picked up in bloods - any change in portal veinous flow should have been picked up on your ultrasound

I know you are asking about liver congestion because it was mentioned in the conditions that can impact fibroscan accuracy. It's a side effect of extreme heart failure and again the congestion is found on ultrasound.

Your bloods are good from your previous posts, you've previously said you have fatty liver and now you are awaiting fibroscan which should hopefully pin down your stage of condition.

Katie

[ToughToes in reply to AyrshireK]

So, portal hypertension and congestion can be seen on a standard ultrasound, not just a doppler ultrasound?

[AyrshireK in reply to ToughToes]

You really don't need to worry about congestion - the heart failure aspect would be obvious before any congestion of the liver and according to what i've read online then yes it is picked up on normal ultrasound.

My hubbies portal hypertension/portal veinous flow direction was always commented on in his normal ultrasound - post transplant they've used dopplar ultrasound to check on flow within the ducts etc. of liver.

[ToughToes in reply to AyrshireK]

Well, today's the day. To say I'm anxious about the fibroscan would be an understatement. When your husband had his, did they tell him the results right away? Or, did he have until they were sent to his doctor and he met with him?

[AyrshireK in reply to ToughToes]

My hubby never had a fibroscan but you should be able to see the results on the screen there and then.

[ToughToes in reply to AyrshireK]

Ok, thx.

[AyrshireK in reply to ToughToes]

Best wishes for it, let us know how you get on. Hopefully it will correlate with the good findings of all your ultrasound scans and things are not as bad as you seem to fear.

Katie

[ToughToes in reply to AyrshireK]

Thanks. I will. 🤞

[ToughToes in reply to AyrshireK]

Hi Katie,

No scarring at all, which is great news. The anount of fat in my liver, however, is a little higher than I thought based on all the ultrasounds I've had in which the radiology report always said "mild fatty liver". Turns out based on the CAP score of 268,I'm just a little over(260) the cut-off between mild and moderate. Bloods (LFT's/enzymes) are all great. So, it's a bit of mixed emotions ony part. Thrilled that my liver has no scarring,but a bit bummed that I have a bit more fat than I thought I did. In your opinion, would you say that the lack ofany scarring is the more important of the two?

[AyrshireK in reply to ToughToes]

No scarring is FABULOUS news. In order to keep it that way you need to tackle the fatty build up and that means shifting any excess weight you're carrying - good healthy food no booze and incressed exercise. The British Liver Trust website has good information on MASLD/NAFLD including a downloadable booklet on how you can treat this yourself with diet and exercise.

Katie

[ToughToes in reply to AyrshireK]

Right. I intend to. But, a CAP score of 268 isn't that bad, is it?

[AyrshireK in reply to ToughToes]

It's S2 (Steatosis Grade 2). Whilst having some fatty change in the liver probably isn't unusual now for us in the Western World (fastest rising cause of liver disease). You definitely want to do all you can to reverse it or else it can continue to S3 over time and that's when you can start to get liver damage.

britishlivertrust.org.uk/in...

britishlivertrust.org.uk/do...

[ToughToes in reply to AyrshireK]

I mean 268 is just slightly over the cut-off of 260 between mild and moderate. I suspect the cause of the difference is that a fibroscan uses exact, precise numbers, whereas on an ultrasound, the assessment is based on the subjective interpretation of the radiologist, rather than exact numbers on a computer.

[AyrshireK in reply to ToughToes]

Ideally you don't want any fat so even if it's S1 it's something you'd want to deal with.

[ToughToes in reply to AyrshireK]

Nash2 says a CAP score of 268 means that 67-73% of the liver is fatty. Yet, he sent me a chart which says for S2 (moderate steatosis) with a CAP score between 261-290, the fat percentage of the liver is between 34-66% . How can a CAP of 268 be 67-73% fat if a CAP of 290, 22 points higher, is only 66%? Is it just me? Or is Nash2's math way off-base?

[AyrshireK in reply to ToughToes]

I don't know what the NASH2 thing is (never heard of it). The Understanding your fibroscan score information i've only ever seen is the following:-

"About Your CAP score

Your healthcare provider will use your CAP score to find out your steatosis grade. Your CAP score is measured in decibels per meter (dB/m). This score will range from 100 dB/m to 400 dB/m. Your CAP score and steatosis grade can go up or down over time.

The following table shows ranges of CAP scores, and the matching steatosis grades. It shows how much of your liver is affected by fat buildup. Normal livers can have up to 5% of fatty changes in them. A score below 238 dB/m means the amount of fatty change in your liver is not higher than normal.

CAP Score Steatosis grade Portion of your liver affected by fatty change

238 to 260 dB/m S1 Less than ⅓ (11% to 33%)

260 to 290 dB/m S2 Between ⅓ and ⅔ (34% to 66%)

290 to 400 dB/m S3 More than ⅔ (67%)

[ToughToes in reply to AyrshireK]

No, I understand that. I've read that several times since you first sent it to me. Nash2 is a person who's a member here. He sends me that same scale/chart showing the percentage of liver fat for S2 ranging from a low of 34% (equal to a CAP of 261) to a high of 66% (equal to a CAP of 290). Then, he says my CAP of 268 is equal to 67-73% liver fat. How can that be possible is what I'm asking when a CAP of 290 (22 points higher than mine of 268) is only 66%. My fat percentage in the liver must be closer to 42-44% , not 67-73%. Right?

[AyrshireK in reply to ToughToes]

A CAP of 268 is at the lower end of S2 - 260 to 290 dB/m - 34% to 66% and at the lower end of that so yes you are correct. Only above 290+ would the S3 and higher % of fatty change kick in.

[ToughToes in reply to AyrshireK]

Exactly! True, even a fat percentage of 40-45% (roughly a CAP of 268) is still a significant amount of fat, but it's nowhere near as high as 67-73% like Nash2 is trying to tell me.

[ToughToes]

On the radiology reports of my last three ultrasounds (2021, 2023 & 2024), portal venous flow was never specifically mentioned. However, it's likely safe to assume that that would be encompassed by statements that were made, such as "the liver is normal in size and homogeneous," and, "There are no abnormalities observed"? Meaning if there was something that looked "off" about the portal vein, it would be specifically noted, but otherwise, not. That's how I'm taking it, anyway.