Ultrasound

[someguy10]

Hello,

I am geno 3a. I finished my tx with  ribavirin and harvoni for 3 months. one more blood test before im officially cured.

I got my ultrasound done post treament and i didnt get the ultrasound report. Can someone please explain.


ultrasound report:

 nearly normal echogenicity,minimal coarseness, without discrete focal solid mass.
nomal flow in main portal vein.

ducts:
no intraphepatic biliary dilation

gall bladder:
no intraluminal filling defects to suggest gallstone sludge or polyp.

impressions:

no significant abnormality
no solid focal masses


what does nearly "normal echogenicity,minimal coarseness, without discrete focal solid mass" mean and "no sigificant abnormality"??




Thanks

[Lynn K]

I would think "no significant abnormality" means they did not see anything to report so that is a good thing.

Definition:
 
Echogenicity (misspelled sometimes as echogenecity) is the ability to bounce an echo, e.g. return the signal in ultrasound examinations
For normal echogenicity I looked to what is not normal

http://radiopaedia.org/articles/generalised-increased-hepatic-echogenicity

Causes of generalized increased liver echogenicity includes:

diffuse fatty infiltration
cirrhosis
chronic hepatitis - can be coarsened as well
infiltration or deposition
     malignant
     granulomata
          tuberculosis
          brucellosis
          sarcoidosis
     glycogen storage disease

So having normal echogenicity is also a good thing

For minimal coarseness I looked at Coarsened hepatic echotexture

http://radiopaedia.org/articles/coarsened-hepatic-echotexture

Coarsened hepatic echotexture is a sonographic descriptor where there uniform smooth hepatic echotexture of the liver is lost. This can occur due to number of reasons which include:

conditions that cause hepatic fibrosis
     cirrhosis
     haemochromatosis

various types of hepatitis
     particularly chronic hepatitis

conditions that cause cholestasis
     choledochal cysts: probably from secondary cholestasis 3
     certain bile duct tumours: will also usually show of accompanying biliary duct dilatation
     biliary atresia

diffusely infiltrating hepatic metastases

hepatic lymphoproliferative diseases
     hepatic lymphoma: although generally presents as a focal liver disease
     hepatic leukaemia

small multiple biliary hamartomas

as a hepatic manifestation of sickle cell disease.

metabolic abnormalities
     hepatic amyloidosis
     glycogen storage disease

So again minimal coarseness is a good thing

without discrete focal solid mass" that is looking for liver tumors which you don't have

So all in all looks like a great biopsy report

But your best source of medical information is your doctor you should check with you personal physician for interpretation of test results

Good luck
Lynn

[someguy10]

Appreciate the clearification. God Bless.

[someguy10]

is liver  advancedfibrosis/cirrhosis considered liver damage?

upper gi endoscopy showed no damage.

[Lynn K]

F3 is advanced fibrosis and F4 is cirrhosis also known as ESLD (end stage liver disease) yes that is considered extensive liver damage.

http://www.mayoclinic.org/diseases-conditions/cirrhosis/basics/definition/con-20031617

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcohol abuse

Cirrhosis occurs in response to damage to your liver. The liver damage done by cirrhosis can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

An upper GI is looking for esophageal varices (kind of like varicose veins inside your esophagus) which can be caused by advanced liver disease (cirrhosis)

http://www.mayoclinic.org/diseases-conditions/esophageal-varices/basics/definition/con-20027505

Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus — the tube that connects the throat and stomach. Esophageal varices occur most often in people with serious liver diseases.

I was found to have esophageal varices and had to have them banded in 2012

Cirrhosis would be diagnosed by liver biopsy, fibroscan test or fibrosure blood test. Indications of cirrhosis can be seen on ultrasound but cirrhosis is not normally diagnosed by ultrasound

Were you told you have cirrhosis? What test was this based on biopsy, fibroscan or fibrosure?

Even people with cirrhosis can have a greatly improved prognosis if they treat their hep c and are cured it will prevent any further liver damage and the possibility exists that some liver healing could occur.

Good luck to you
Lynn

[someguy10]

i was diagnosed with hep c few yrs back. i finished my tx in june and will be officially cured after next week test. Doctor only did the ultrasound and based on that he thinks i might have cirrhosis. Never done a biopsy, fibroscan or fibrosure. After my upper gi, the nurse told me i didnt have any liver damage.

[Lynn K]

I don't know how they could determine no liver damage by upper endoscopy that is looking for enlarged blood vessels which can occur with cirrhosis you could still have F3 fibrosis or F4 cirrhosis without varicies being present.

What kind of doctor are you seeing a gastroenterologist? I would get my diagnosis from my doctor rather than from a nurse. To know if you have cirrhosis you need to have a liver biopsy or a fibroscan test or a fibrosure blood test.

http://www.m.webmd.com/a-to-z-guides/tc/cirrhosis-exams-and-tests

Other tests
Other tests also may be done to confirm cirrhosis or to look for possible complications. These include:

Liver biopsy. This is the only test that can confirm cirrhosis. Looking at liver tissue also may reveal signs of inflammation.

[Lynn K]

http://www.myliverexam.com/en/lexamen-fibroscan.html

https://en.m.wikipedia.org/wiki/FibroSure

[mrcat211]

Lynn K

Started Harvoni today for 12 weeks! Hurray!!! A huge step forward and a few steps back all in the same day.
Received results from my endoscopy and colonoscopy of last week and I have large gastric varices now also.
Im guess Im just surprised that Im surprised- and sad.
I just recently found out that I am F4 Cirrhosis when just a couple of months ago I was F2-3.
Not trying to be a complainer here at all. I am very grateful and fought like hell to get the Harvoni approved, even had to get a lawyer involved. Its been a long road to get to this point and now that I'm here, I feel defeated before I have even really started.
Dr. said that if treatment doesn't work, then it's on to transplant but in the meantime we have to deal with these varices.
I'm so scared.
Has anyone else had to deal with gastric varices?

[Lynn K]

Hi mrcat211

I was diagnosed with cirrhosis F4 on liver biopsy in January 2008. I had an upper endo at that time and had grade 1 esophageal varicies. Two years later they were grade 2 and the following year 2012 they were grade 3 requiring banding to prevent the risk of bleeding out. I had 4 sessions of banding via upper endoscopy once a month to get them all.

I was checked again at 6 months and am now checked annually for re-occurrence.

As a Child Pugh score "A" and a MELD score 8 I am not even eligible for the liver transplant list. I believe you have to be a MELD of at least 12 or possible 15 depending on the center to be listed and most don't receive a transplant until they have a MELD around 30.

My Child score and MELD score have held steady since I was diagnosed so any my point is even cirrhosis is not a death sentence or even meaning you have a transplant in your future even without cure.

But with cure we will no longer progress with our liver damage and it may be possible our livers could improve with time like years of time. Also although we are still at risk for HCC with cure our risk is greatly reduced although we will still need to be checked every 6 months with abdominal ultra sound and AFP blood testing to look for early signs of liver cancer.

But with cure we can go on to life to our full life expectancy in all probability.

Best to you and wishing you SVR forever,
Lynn

[mrcat211]

Lynn K
Thank you so much! I am just nervous I suppose and in getting all this info in such a short time it has been a bit overwhelming. I am glad to hear you have SVR and hope I can one day be your SVR buddy!. Dr. said that yes we will monitor the varices and that they don't want to do anything other than medicate with beta blockers for now. So we shall see.
Thanks again

[Lynn K]

I couldn't take beta blockers the goal with them is to lower the heart rate to about 60 BPM and my resting HR is already there and sometimes in the 50's so no beta blockers for me. That was why I was banded as mine were grade 3 and had to be addressed.

My endoscopy report also says portal hypertensive gastropathy but it is mild at this point

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916868/

Yeah when my doctor told me I had cirrhosis it was the only time I almost cried at a doctors appointment. I did get more than a little choked up.

[Debula]

I totally understand how you feel.  One minute so excited to be taking Harvoni and at the same time scared that something else is going wrong.
I just started my last bottle of Harvoni today (Day one of my 21st week) and got a call from my doctor (who BTW never calls me in person) and he informed me that my last Ultrasound revealed a tumor about 5cm
I did cry for a minute and them pulled my big girl pants up and decided that I can't be upset yet because we don't know if it is cancer yet.
I thought how ironic that I am almost done with Harvoni and now this happens? WTF?
Anyway...going to stay positive and try not to freak out until I know more
He is ordering an MRI for me so not sure how long it will take for me to get an appointment.
This thing whatever it is grew to almost 2 inches in 8 months.  My last CT was at X-mas and it wasn't there or couldn't be seen then.
Hope all goes well for you.  I have to have those tests too and I am so dreading it
Be well
Deb

[KimInTheForest]

Hi Deb. I hope your MRI provides some good news! This may sound like a dumb question, but are they sure what they saw on your liver ultrasound is a tumor? You would not believe the number of times that ultrasounds and even an MRI once revealed something in me (in various places) that doctors were convinced was a tumor and were all ready to go yarding out some part of my body. It always turned out to be an enlarged lymph node, which is part of the ExtraHepatic Manifestations of chronic HCV. Very few doctors seem to have any knowledge at all of EHMs, and they don't believe you when you tell them. Very glad I hung on to my ovaries and other innocent body parts that doctors were keen to remove unnecessarily.

And MrCat, I hope all goes well with your gastric varices. It sounds like there are ways to deal with that.

Good luck to both of you!

best,
kim

[Lynn K]

Hi Deb

Hoping for the best for you with the MRI. That its some sort of benign object. I have never had one thankfully so far I haven't needed to.

That is my fear for all of us who are cured but have cirrhosis, HCC.

Good luck

[mrcat211]

Hi Deb- Boy of boy I feel you! I am so sorry but as other have said it may very well be a benign bump of no worry. But yes...everytime I feel like something is finally going in a positive direction I feel like another brick wall is set before me. Hang in there!

Kimintheforest- yes I too have had doctors in the past just give me plenty of bad new. Unfortunately most of it was warranted. Female cancers run very strong in my family so I had the total hysterectomy to remove it all as we did find cancerous cells very early thank goodness. Already had my kids so I wasn't too worried about that part. My grandmother died of cervical cancer so I decided out with it all. I am also BRCA1 gene positive so at some point down the road I have to give serious thought to a double mastectomy.

Lynn K- Yes my fear exactly too. In fact, I never had imagined I would have varices in my stomach, I honestly thought one of these times...during one of these tests they would find HCC. I think I was almost preparing for that. The varices however, have just got me side swiped. There are less they can/want to do for them other than the beta blocker meds for now. They can not be banded like the esophageal varices and they usually only perform the TIPS shunt in/after a bleed. SO that is why I am so scared! I feel like at any given moment it might just blow and I might bleed to death. So I am just having a really hard time with it. I am already vegan, gluten and dairy free. Now I need to remove acidic and "sharp" foods from my diet as well. No more popcorn or chips and salsa- oh well. I wouldn't even care if I were just down to water- I just want to live long enough to see my kids marry and have kids of their own maybe.
Sorry for rambling...

[Lynn K]

And then the TIPS procedure has it's own set of problems. I understand it greatly increases the possibility of developing HE. Hopefully the Beta blocker will do the trick I believe it is very effective. Also there is cauterization that can be done not sure if it is laser or maybe cold they can also inject drugs into the blood vessel to make it collapse

[Lynn K]

Interesting article talking about the use of cyanoacrylates (AKA super glue)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312167/

[mrcat211]

Lynn K
Thank you, great article. I will ask my dr. about these procedures. Not sure why they want to just use the beta blockers. If it were up to me I would choose to have it removed, zapped, deflated or something!
When you had a bleed, how did you know it had happened?
Thanks again

[Lynn K]

As far as I can see beta blockers are the first choice. If the varicies are large they go for more aggressive measures. Do you know what grade varicies you have? Mine were grade 3 there is only grade 1,2, or 3. I also read they may just say small or large. Also another thing if the endoscopy report said something like red wale signs those would indicate close to bleeding.

I believe if you are having a mild constant bleed you would become anemic basically from blood loss. Might notice black tarry stools which is digested blood.

The bad stuff if you have a major bleed you could vomit what looks like coffee grounds again partly digested blood or even have large amounts of red blood being vomited and due to blood loss you could lose consciousness. A bleeding episode from portal hypertension is one of the ways cirrhosis kills. Sorry about the harsh vision here.

here is a web MD article with similar information

http://www.webmd.com/digestive-disorders/bleeding-varices

I have also read that if cured of hep c our odds of this happening is also reduced I think to near zero.

I never had a bleed mine were found on my 3rd upper endoscopy.

When I was 1st diagnosed with cirrhosis my doctor had me get an upper endo right away. I had grade 1 varicies. So we waited 2 years to repeat and they were grade 2. When repeated the next year they were grade 3 so then I had an upper endo every month for the next 4 months to band and eradicate the varicies.

I was checked at 6 months and again at 1 year with no occurrence. I am now checked every year. I went into watchful waiting mode spring 2013 so I did an annual recheck in spring 2014 and 2015.

[mrcat211]

Lynn K
Thank you for all your informative info and help! I REALLY REALLY APPRECIATE IT SO VERY MUCH!
Have you had the Alpha fetoprotein- AFP tumor marker blood test done?
I just got mine back with horrific results Normal range is
0.0 - 8.3. My level is 129.9!!! I am waiting to hear from the doctor. Recent ultrasound I had done looked ok but these test results are over the top!

[Lynn K]

I get an AFP test done every 6 months along with abdominal ultrasound

8/2/13      AFP  26.6
1/7/14      AFP  26.3
6/17/14    AFP  14.9 (Just finished Sovaldi/Olysio)
12/16/14  AFP  15.6 (Just started Harvoni)
5/4/15     AFP  13.4 (Finished Harvoni)


AFP is an imperfect tumor marker that is why it is used in conjunction with ultrasound.

here is a link to more information but from what I understand they are looking for numbers above 500 before it is a concern. This is more for trend information

https://labtestsonline.org/understanding/analytes/afp-tumor/tab/test/

When the AFP concentrations of people with chronic liver disease go from moderately elevated to greatly elevated, their risk of developing liver cancer increases. When total AFP and AFP-L3% are significantly elevated, then the affected person has an increased risk of having or developing hepatocellular carcinoma in the next year or two. However, both AFP and AFP-L3% concentrations can be elevated, and fluctuate, in people with chronic hepatitis and cirrhosis. In these cases, a sharp increase in AFP is more important than the actual numerical value of the test result.

Not every person with increased AFP and AFP-L3% test results has cancer or will develop liver cancer. The AFP and AFP-L3% tests are not diagnostic; they are indicators. They must be used in conjunction with information from a history and physical examination as well as imaging studies to look for the development of tumors. Although these tests can provide useful information, they are not as specific or sensitive as doctors would wish. AFP can temporarily increase whenever the liver is injured and regenerating, and moderate elevations can be seen with a variety of conditions. Because of this, AFP testing can give some false positives. In addition, not every cancer will produce AFP, so a person could still have cancer even when the AFP is normal. For these reasons, the AFP test should not be used to screen the general population for cancer.

[mrcat211]

Thanks Lynn
Yes I read this info also. Makes sense that they are more looking for a sharp increase. I guess I will have to just wait and see.

[Debula]

Thank you all for your input and encouragement .
Kim this was told to me by GP so I am going to get the MRI and go to my liver doctor and see what he says .  My GP did say that most if the time they are benign. I will see as many docs as it takes to be sure

Why didn't they give me the APF tumor marker?

Mrcat I wish you all the best.  I have to go for my upper endo soon too

Lynn you are a life saver with your wealth of information

All of you keep well
I will update when I know more.  I hope you do too
Deb

[Lynn K]

Hi Deb

From my understanding the protocol for monitoring those of us with cirrhosis is we should have an abdominal ultrasound (or similar) test every 6 months along with and AFP alpha-fetoprotein blood test to monitor for liver cancer.

Even though I am clear of hep c (knock on wood) at a minimum I expect I will be doing this testing for the rest of my life also an annual upper endoscopy for at least the foreseeable future to check for a re-occurrence of my esophageal varicies.

Looking at the AASLD HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

http://www.hcvguidelines.org/full-report/monitoring-patients-who-are-starting-hepatitis-c-treatment-are-treatment-or-have

Recommended follow-up for patients who achieve a sustained virologic response (SVR).

For patients who do not have advanced fibrosis (ie, those with Metavir stage F0-F2), recommended follow-up is the same as if they were never infected with HCV.

Rating: Class I, Level B

Assessment for HCV recurrence or reinfection is recommended only if the patient has ongoing risk for HCV infection or otherwise unexplained hepatic dysfunction develops. In such cases, a quantitative HCV RNA assay rather than an anti-HCV serology test is recommended to test for HCV recurrence or reinfection.

Rating: Class I, Level A

Surveillance for hepatocellular carcinoma with twice-yearly ultrasound testing is recommended for patients with advanced fibrosis (ie, Metavir stage F3 or F4) who achieve an SVR.

Rating: Class I, Level C

A baseline endoscopy is recommended to screen for varices if cirrhosis is present. Patients in whom varices are found should be treated and followed up as indicated.

Rating: Class I, Level C

Assessment of other causes of liver disease is recommended for patients who develop persistently abnormal liver tests after achieving an SVR.

So I see they don't mention AFP testing but have seen that other places.

http://depts.washington.edu/hepstudy/presentations/uploads/18/m2_l6_hcc_surveillance.pdf

Surveillance: applying screening tests at regular
intervals in patients at risk for HCC

Most commonly used surveillance in clinical
practice: ultrasound and alpha-fetoprotein (AFP)
every 6 months

The added value of AFP to ultrasound in
surveillance has been questioned. AFP no longer
included in 2011 American Association for the Study
of Liver Disease (AASLD) guidelines; used in
European Association for the Study of the Liver
(EASL) and Asian Pacific Association for the Study
of the Liver (APASL) guidelines

OK looks like AFP is of questionable usefulness per several sources

Researched myself into a corner on that one lol

[Debula]

Haha but what would we do without you?

My dr did indicate that I will have to have an ultrasound every 6 months for the rest of my life and he made me promise to go back for upper endo as well as a colonoscopy  . This was before the tumor was discovered.
I guess all I can do is wait and see what the MRI shows and go from there.  I suppose I should start thinking about the endoscopy too since I DID promise I would do it after I finished treatment and I am almost there.

Thanks again

Deb

[terih]

Deb, I have my hopes up, for you, that this turns out to be absolutely nothing! Please let us know as soon as you find out! Try to think positive, I know it's tough to do when you're faced with things like this. Just know, we are all rooting for you! Teri

[Debula]

Thanks Teri I am trying to think positive.  There is no point freaking out over something I don't know about yet.  Hopefully it will just be some benign mass.

I just looked at your stats and I am sorry to see that you relapsed after 12 weeks of Harvoni.  I can't even imagine what that must feel like.  What's next for you?  Hopefully the next time will work.

We are all rooting for you too!

I love this community

Be well everybody

Deb

mrcat I didn't mean to hijack your thread but it seemed appropriate to post my ultrasound results here

[beto]

Hey y'all
 Found a coolio link for fibroscan scores.  What I found very interesting is the color coded scale; if you scroll down a bit.  It breaks up the scores for stiffness and the scores differ depending on the affliction.  makes me wonder if a hep C person that moderately imbibed, or took Tylenol or did other liver compromising things and is now completely alcohol free, might notice a score drop after achieving normal enzymes and viral load drops from Harvoni type meds, as well as, life style changes.   
http://hepatitiscnewdrugresearch.com/fibroscan-results-the-scoring-card.html

The link also discusses everything you need to know about liver scans.

Also...I am an optimist and believe that nothing is written in stone and am of a growing camp that believes a least a partial recovery from fibrosis can be achieved.  I want to be careful as this is a forum and I am not an MD.  I myself, and others have posted encouraging studies that favor the notion of reversal potential, elsewhere on the Hep Forum pages.  I have witnessed many examples in my life time whereby medical and scientific facts have be successfully rebutted and new information dispatched.  I think being "hopeful" is not harmful, and in fact, preferable.

[beto]

Hey y'all
 Found a coolio link for fibroscan scores.  What I found very interesting is the color coded scale; if you scroll down a bit.  It breaks up the scores for stiffness and the scores differ depending on the affliction.  makes me wonder if a hep C person that moderately imbibed, or took Tylenol or did other liver compromising things and is now completely alcohol free, might notice a score drop after achieving normal enzymes and viral load drops from Harvoni type meds, as well as, life style changes.   
http://hepatitiscnewdrugresearch.com/fibroscan-results-the-scoring-card.html

The link also discusses everything you need to know about liver scans.

Also...I am an optimist and believe that nothing is written in stone and am of a growing camp that believes a least a partial recovery from fibrosis can be achieved.  I want to be careful as this is a forum and I am not an MD.  I myself, and others have posted encouraging studies that favor the notion of reversal potential, elsewhere on the Hep Forum pages.  I have witnessed many examples in my life time whereby medical and scientific facts have be successfully rebutted and new information dispatched.  I think being "hopeful" is not harmful, and in fact, preferable.