I was just diagnosed F3 with NAFLD but all blood tests normal what now?

[ShatteredGrL]

My story is somewhat complicated by the fact that I did have Hep C from 2009-2020, now cured. My fibroscan and fibrotest showed F1 in 2018. No repeat scans were done before cure of Hep C but I had been stable since 2012 at F1 (was told this was normal no concerns). In 2009 also diagnosed with NAFLD. Was told this is nothing to worry about. I lost 15% of my weight in 2021 and have kept it off. Naturally I assumed all was well until I started having daily RUQ pain. US showed fatty liver and possible beginning cirrhosis. Elastography revealed F3, they did not give CAP score. My doctor says that being obese could make the elastography inaccurate. My fibrosis test showed F0. What do I believe and what follow up do I need? I live in a rural area and my doctor worries the radiologists are over reading the elastography and ultrasound. I see GI this week but I don’t know what to ask for and I don’t want to be dismissed. My internal med PCP admits she just doesn’t know.

[Realy]

Did you have a fibrosis blood test as well? And wich type? Many things can affect fibroscan .

[ShatteredGrL in reply to Realy]

I had fibrotest Actitest serum this time. It’s actually not the right test because I don’t have hepatitis anymore so the actitest part means nothing. The blood test showed F0 A0. Previously in 2018 I had the fibrosure test which showed F1 A1. The ultrasound showed “Fatty infiltration of the liver with no masses. Subtle nodular contour could represent early cirrhotic change.” The Elastography follow up showed

“FINDINGS:

LIVER: Diffusely coarsened hepatic echotexture without focal hepatic mass.

E Median Value: 9.8 kPa

E IQR/Median Percentage: 21.1%

IMPRESSION:

Diffuse hepatic parenchymal disease.

Liver fibrosis staging moderate/severe.

METAVIR score F3

[ShatteredGrL in reply to ShatteredGrL]

All my tests were done from 7/18- 7/22. Close enough together they should show same results.

[goldencody]

You need to have a liver biospy.

[ShatteredGrL in reply to goldencody]

I was afraid of that. I had one years ago and it was awful, they didn’t so much as even numb the skin. I was really hoping to avoid it. Has anyone had an MRI elastography?

[goldencody in reply to ShatteredGrL]

I would confirm that the area will receive a local and asked fir an anti anxiety drug to relax

[Jkf1 in reply to ShatteredGrL]

My doctors and I both feel that biopsies are extremely invasive. They are Only as good as the sample that is taken. Obviously, they can't take your whole liver. I would only put yourself through this if it is absolutely necessary.

[ShatteredGrL in reply to Jkf1]

what tests did you have instead?

[lusitania84 in reply to ShatteredGrL]

I believe I would try to get an MRE instead of a biopsy if possible. From the little bit of research I've done. It is a very solid test.

[ThyroidDeb]

I have not had an MRI elastography since I had biopsy was told it was not needed. I didn't have a lot of problems with the biopsy. It wasn't fun but for me the initial shot was most painful but I hated lying on my side for an hour then I could sit up but couldn't get off the bed for 3 more hours except for the bathroom. No TV, nothing to occupy the time and I was there over lunch and wasn't offered anything but water!

[Kjun54321]

My doctor did a liver biopsy during an endoscopy. Was able to check my hiatal hernia too. 2 birds with 1 stone. Might be something good for you to do. My fibroscan showed f3 when I’m actually f1 NASH.

[ShatteredGrL in reply to Kjun54321]

Interesting. I assume the inflammation from the NASH was the cause of the false high? Did your blood work show inflammation?

[Realy in reply to ShatteredGrL]

Did you get to Dr yet? And what dis he think?

[ShatteredGrL in reply to Realy]

So yes went to GI…My scan said f3, blood work says f0, gi said scan is more reliable, but I should get a bx to confirm. He said often blood starts to look normal as you progress to cirrhosis from fibrosis so blood is only good up to a point. However bx confirmation doesn’t change treatment from what he said just closer f/u. But if bx confirms then I do scans and blood work every 6 months, and if I don’t get bx I do scans and blood q6 months. If next scan is better then we assume 1st scan overestimated and scan in another year (why would we not question the second scan?). So bx could prevent a lot of expensive fu so do it or not much gain so don’t do it? The consult was not very helpful.

[Kjun54321 in reply to ShatteredGrL]

Better to know and learn exactly the correct diagnosis. Could determine what you’ll need to take in the future. Good luck. Also, I do have inflammation but not sure if this is causing the liver problems.

[isi123]

liver biospy is the most logical option when there are conflicting reports