Hepatitis C Support Group
Hepatitis C is a blood-borne viral disease which can cause liver inflammation, fibrosis, cirrhosis and liver cancer. The hepatitis C virus (HCV) is spread by blood-to-blood contact with an infected person's blood. Many people with HCV infection have no symptoms and are unaware of the need to seek treatment. Hepatitis C infects an estimated 150-200 million people worldwide.
Cirrhosis results from the necrosis of the liver cells. It is characterized by fibrosis, formations of scar tissue and regenerative nodules. The disease of Cirrhosis and its stages leads to some or complete loss of liver function. It may occur at any age of life.
CAUSES OF CIRRHOSIS
Cirrhosis is most commonly caused by extensive and excessive drinking of alcohol. There are other causes which include:
* Postnecrotic cirrhosis
Hepatitis B
Hepatitis C
* Non-alcoholic fatty liver disease
* Autoimmune disease
Primary sclerosing cholingitis Stages of the Liver Disease Cirrhosis
Autommune hepatitis
* Metabolic disorders
Hemochromatosis
Wilsons disease
Alpha-antitrypsin defeciency
Galactosemia
* Biliary
Primary biliary cirrhosis
Secondary biliary cirrhosis
Cystic fibrosis
* Genetic
Hemochromatosis
Wilsons disease
* Chronic venous outflow obstruction
Budd-Chiari syndrome
PATHOLOGY OF CIRRHOSIS
Liver cirrhosis is characterized by the formation of regenerative nodules with loss of normal structure. There are three types of cirrhosis:
a- Micronodular Cirrhosis:
In this type, the whole of the liver is uniformly involved. Regenerative nodules are on the small side being less than 3mm in size. This is due to excessive alcohol consumption
b- Macronodular Cirrhosis:
In this type, some sections of the liver are normal. The size of the nodules will be variable and this type of cirrhosis is seen in chronic viral hepatitis.
c- Mixed Cirrhosis:
In some cases, a mixture of both small and large nodules are visible on and through the liver
There are 4 stages of liver cirrhosis. Knowledge about the stages of liver cirrhosis is important for better prevention, early diagnosis and effective preventative treatment. Stage 1 is the earliest stage which is characterized by minimal damage and a good prognosis for recovery and prevention whereas in the final stage 4, the liver is virtually completely damaged and a liver transplant is the only treatment of choice. Read on to find out more about the different stages of cirrhosis:
STAGE 1.)The first stage is known as the compensated stage.
This stage is characterized by inflammation of the liver tissues. Inflammation is confined to the portal area and does not involve other areas of the liver. This inflammatory process leads to minor connective tissue formation and scarring of the liver. But as the name says, these changes can be compensated for by the body, meaning the body will adapt to offset the disease effects. This stage is usually asymptomatic but on close examination, some patients may have:
* Mild jaundice * Fatigue * Loss of appetite * Weight loss * Dry mouth
* Nausea * Swelling of the abdomen * Abdominal pain
STAGE 2.)The second stage of cirrhosis is also characterized by inflammation of the liver tissues, but at this stage, the liver starts to show areas of fibrosis. Fibrosis are the stiff bands that are formed by the replacement of normal liver tissues with the scar tissue. It is irreversible and can never return back to normal liver tissue, however, new liver cells can generate. In this stage, inflammation is not only limited to the portal area,but involves the whole liver. The changes in this stage can be compensated for by the body.
STAGE 3.)In the third stage, the inflammation and fibrosis start to involve other areas of the liver and the condition becomes more severe. As the fibrosis extend to the other tissues, it forms bridging fibrosis. Bridging fibrosis not only impairs the normal functioning of the liver but also affects the blood pressure levels in the liver, a condition known as portal hypertension. A patient with stage 3 cirrhosis will not be able to digest fat so he may present with fat-soluble vitamin deficiencies (Vitamin A, D, E and K).
STAGE 4.)Stage 4 of liver cirrhosis is also known as the "Decompensated stage" or End Stage Liver Disease (ESLD).
It is the most advanced stage and in this stage, the body can no longer compensate for the damaged liver. Fibrosis extends to every part of the liver and a liver transplant is needed to save the patients life. Stage 4 may also involve the spleen and kidneys. A patient with the 4th stage of liver cirrhosis may develop the following symptoms in addition to the symptoms of the 1st stage: * Fever * Pedal edema
* Ascites * Jaundice * Pruritis * Plamar erythema * Easy bruising
* Bleeding.
Stage 4 liver cirrhosis increases the risk of many complications.e.g. Ascites, variceal hemorrhage, spontaneous bacterial peritonitis, hepatic encephalopathy and liver cancer. Some of these complications can be life-threatening.
INVESTIGATIONS OF CIRRHOSIS:
The following tests are performed to check which stage and what type of liver cirrhosis the patient may have:
Liver function tests ( Albumin, Prothrombin time)
Liver biochemistry ( Serum alkaline phosphatase, Serum aminotransferase)
Serum electrolytes ( Sodium level)
Serum creatinine
Viral markers
Serum autoantibodies
Serum immunoglobulins
Iron indices and ferritin
Copper, ceruloplastin
Alpha-antitrypsin
In addition to these laboratory investigations, imaging studies check for the changes in the size and shape of the liver. Some of these include Ultrasound, CT scan, Endoscopy and MRI scan. A liver biopsy is usually necessary to confirm the type and severity of liver disease.
MANAGEMENT OF CIRRHOSIS of the Liver:
In the compensated stage, treatment of the underlying cause of cirrhosis can reverse the cirrhotic changes in the liver if caught early enough and patients can lead a normal life. Patients should reduce their salt intake and should avoid aspirin, NSAIDS and alcohol. In the de-compensated stage, management of complications should be done. Ultrasound tests should be done after every 6 months to detect the early development of hepatocellular carcinoma. A liver transplant is usually needed in the 4th stage.
PROGNOSIS OF CIRRHOSIS:
In general, the survival rate of cirrhosis is 50% but this varies with the etiology, stage and presence of complications.
Much can be done through early intervention and looking at lifestyle factors such as the foods you eat and following a strict liver friendly diet, complimentary medicines,no alcohol,exercise, supplements to boost your whole system and especially taking care to look after yourself on every level when you have cirrhosis of the liver.
Please use this as you wish. I posted this because I noticed that there is some confusion in this forum regarding the progressive stages and treatments available as well especially certain diets that are helpful in preventing the liver from progressing to rapidly from one stage to the next which is the key to surviving and avoiding the decompensated stage(4) where only a transplant can treat such a damaged liver for now. One day this may change for the better but until then, the best we can do is to stop it's progression and aid in regenerating new liver cells which if done efficiently enough can promote improvement in liver function.
All the best to you & Bless you all. PEACE.
CAUSES OF CIRRHOSIS
Cirrhosis is most commonly caused by extensive and excessive drinking of alcohol. There are other causes which include:
* Postnecrotic cirrhosis
Hepatitis B
Hepatitis C
* Non-alcoholic fatty liver disease
* Autoimmune disease
Primary sclerosing cholingitis Stages of the Liver Disease Cirrhosis
Autommune hepatitis
* Metabolic disorders
Hemochromatosis
Wilsons disease
Alpha-antitrypsin defeciency
Galactosemia
* Biliary
Primary biliary cirrhosis
Secondary biliary cirrhosis
Cystic fibrosis
* Genetic
Hemochromatosis
Wilsons disease
* Chronic venous outflow obstruction
Budd-Chiari syndrome
PATHOLOGY OF CIRRHOSIS
Liver cirrhosis is characterized by the formation of regenerative nodules with loss of normal structure. There are three types of cirrhosis:
a- Micronodular Cirrhosis:
In this type, the whole of the liver is uniformly involved. Regenerative nodules are on the small side being less than 3mm in size. This is due to excessive alcohol consumption
b- Macronodular Cirrhosis:
In this type, some sections of the liver are normal. The size of the nodules will be variable and this type of cirrhosis is seen in chronic viral hepatitis.
c- Mixed Cirrhosis:
In some cases, a mixture of both small and large nodules are visible on and through the liver
There are 4 stages of liver cirrhosis. Knowledge about the stages of liver cirrhosis is important for better prevention, early diagnosis and effective preventative treatment. Stage 1 is the earliest stage which is characterized by minimal damage and a good prognosis for recovery and prevention whereas in the final stage 4, the liver is virtually completely damaged and a liver transplant is the only treatment of choice. Read on to find out more about the different stages of cirrhosis:
STAGE 1.)The first stage is known as the compensated stage.
This stage is characterized by inflammation of the liver tissues. Inflammation is confined to the portal area and does not involve other areas of the liver. This inflammatory process leads to minor connective tissue formation and scarring of the liver. But as the name says, these changes can be compensated for by the body, meaning the body will adapt to offset the disease effects. This stage is usually asymptomatic but on close examination, some patients may have:
* Mild jaundice * Fatigue * Loss of appetite * Weight loss * Dry mouth
* Nausea * Swelling of the abdomen * Abdominal pain
STAGE 2.)The second stage of cirrhosis is also characterized by inflammation of the liver tissues, but at this stage, the liver starts to show areas of fibrosis. Fibrosis are the stiff bands that are formed by the replacement of normal liver tissues with the scar tissue. It is irreversible and can never return back to normal liver tissue, however, new liver cells can generate. In this stage, inflammation is not only limited to the portal area,but involves the whole liver. The changes in this stage can be compensated for by the body.
STAGE 3.)In the third stage, the inflammation and fibrosis start to involve other areas of the liver and the condition becomes more severe. As the fibrosis extend to the other tissues, it forms bridging fibrosis. Bridging fibrosis not only impairs the normal functioning of the liver but also affects the blood pressure levels in the liver, a condition known as portal hypertension. A patient with stage 3 cirrhosis will not be able to digest fat so he may present with fat-soluble vitamin deficiencies (Vitamin A, D, E and K).
STAGE 4.)Stage 4 of liver cirrhosis is also known as the "Decompensated stage" or End Stage Liver Disease (ESLD).
It is the most advanced stage and in this stage, the body can no longer compensate for the damaged liver. Fibrosis extends to every part of the liver and a liver transplant is needed to save the patients life. Stage 4 may also involve the spleen and kidneys. A patient with the 4th stage of liver cirrhosis may develop the following symptoms in addition to the symptoms of the 1st stage: * Fever * Pedal edema
* Ascites * Jaundice * Pruritis * Plamar erythema * Easy bruising
* Bleeding.
Stage 4 liver cirrhosis increases the risk of many complications.e.g. Ascites, variceal hemorrhage, spontaneous bacterial peritonitis, hepatic encephalopathy and liver cancer. Some of these complications can be life-threatening.
INVESTIGATIONS OF CIRRHOSIS:
The following tests are performed to check which stage and what type of liver cirrhosis the patient may have:
Liver function tests ( Albumin, Prothrombin time)
Liver biochemistry ( Serum alkaline phosphatase, Serum aminotransferase)
Serum electrolytes ( Sodium level)
Serum creatinine
Viral markers
Serum autoantibodies
Serum immunoglobulins
Iron indices and ferritin
Copper, ceruloplastin
Alpha-antitrypsin
In addition to these laboratory investigations, imaging studies check for the changes in the size and shape of the liver. Some of these include Ultrasound, CT scan, Endoscopy and MRI scan. A liver biopsy is usually necessary to confirm the type and severity of liver disease.
MANAGEMENT OF CIRRHOSIS of the Liver:
In the compensated stage, treatment of the underlying cause of cirrhosis can reverse the cirrhotic changes in the liver if caught early enough and patients can lead a normal life. Patients should reduce their salt intake and should avoid aspirin, NSAIDS and alcohol. In the de-compensated stage, management of complications should be done. Ultrasound tests should be done after every 6 months to detect the early development of hepatocellular carcinoma. A liver transplant is usually needed in the 4th stage.
PROGNOSIS OF CIRRHOSIS:
In general, the survival rate of cirrhosis is 50% but this varies with the etiology, stage and presence of complications.
Much can be done through early intervention and looking at lifestyle factors such as the foods you eat and following a strict liver friendly diet, complimentary medicines,no alcohol,exercise, supplements to boost your whole system and especially taking care to look after yourself on every level when you have cirrhosis of the liver.
Please use this as you wish. I posted this because I noticed that there is some confusion in this forum regarding the progressive stages and treatments available as well especially certain diets that are helpful in preventing the liver from progressing to rapidly from one stage to the next which is the key to surviving and avoiding the decompensated stage(4) where only a transplant can treat such a damaged liver for now. One day this may change for the better but until then, the best we can do is to stop it's progression and aid in regenerating new liver cells which if done efficiently enough can promote improvement in liver function.
All the best to you & Bless you all. PEACE.
My first G.I. Doctor was outdated by at least 10 years...so were the 7 associates I saw after him.
I literally recognized the outdated quotes they were using.
This read isn't for everyone, and is hardly cutting edge 5 years after publication. It does however explain why we now see cirrhosis as a "dynamic" state of liver health as verses a static..."you are dying" state.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882065/
How does being unable to digest fat affect the body?
My last MRI of the abdomen late in July said 'liver is slightly nodular, suggesting Cirrhosis. I'm not planning another MRI until the end of this coming July.
I'm having no more ascites now, and haven't had fluid removed in iver 6 months. Had that checked a few days ago - no fluid. But my abdomen is bigger than it should be, and sometimes uncomfortable. I don't know if it's changes due to the transplant in 2010 (the MRI's always say that), or if it's Cirrhosis. My Houston doctor doesn't do the fibroscan, so guess I'll wait for the MRI in July to get a better idea of what's going on.
Meanwhile, my creatinine is getting better since I'm not taking diuretics now, and my red and white blood cells and hemoglobin are slightly improved. Iron is low, so I'm taking iron pills and eating more iron rich foods. Liver functions tests, INR, and bilirubin are all in normal ranges. I'm not as thin as I was for over 3 years. Just don't like having the constant big belly, but maybe there's scar tissue from the transplant.
Thanks for listening to my list of stuff. You always have a take on my symptoms, which helps tremendously. I'll be seeing my nurse practitioner in about 10 days to follow up.
Still praying for your surgery at the end of the month to go well. Marilyn
Tomorrow I find out the exact date for my procedure from my lung doctor.
With respect to what's happening to you post tx and now being SVR is the slower than usual, yet steady improvement in various aspects within your various body systems originating with the transplanted liver and the problems prior to and afterwards due to HCV and HCC. Ther are various systems that will improve much faster than others as you notice from the improvement in your creatinine level.
With respect to wondering why you have a bigger abdomen and the sometmes discomfort is normal because after all your insides were moved around quite a bit from both the surgery and when the large amounts of fluid from ascites and you probably got your appetite back and need to moderate your diet slightly. Look, you're going to have to work really hard to get your abdomen to return to it's normal size and because your skin in the abdomen was constantly being stretched is another reason why it feels so big currently also.
Your liver is going to take longer to replace enough of the damaged cells before there's any real improvement but already it more healthy than it was prior to tx because you stopped the progression of the deteriorating effects of those HCV buggers cold and dead in their tracks so the good part is that there's no more deterioration going on and the regenerating and repairing process is starting to begin which is another miracle indeed!
Your blood numbers reflect the slow yet steady improvement in your liver function as well. So your future looks very bright Marilyn!
Finally, it's always been my pleasure to assist you in any way I could over the course of knowing you as a genuine friend whom I genuinely care very much. So ask away sweetie and I'll see what i can come up with because you know I'll be around to respond and help if I can. Oh, and just in case you're unaware of this - you have helped me in so many ways over the years because that's what friends are for! Dios te bendigas siempres mi amiga!
The bottom line is that everybody does heal differently and there are too many factors to consider which is why any educated individual whether it be layman like myself or a nurse or doctor is not going to give you an answer to accurately predict your outcome after SVR. Instead, they monitor you for the long term to see if there's any regeneration happening mostly based on the variety of diagnostic test results.
And even then I would question the accuracy of my prognosis should they tell me that everything is beautiful and there's no more damaged tissue that has been replaced with regenerated, healthy liver cells. Because your liver even though it was transplanted did go through some wicked trauma while being attacked by not only HCV but, also by your own confused immune system that was already led to believe that your liver was indeed part of you by weakening it. So the combination of these two factors played a role in creating chaos in your body and now that it has finally stopped, the time it takes for everything to function normally as it should will take some time of at least a few years.
If you treat your body well, it will react well and heal as it should so you got that going for you Marilyn. However, it's really hard if not improbable to predict how much and how long it will take before your liver will get back to the condition it was in prior to becoming re-infected with the hidden and dormant HCV that was still in your body, but it will get better and that is something to keep you optimistic in eventual regeneration and recovery from such trauma.