"There's a myth that anyone who has a liver problem has brought it on themselves" This quote is from a Crohn's disease patient living with a blocked portal vein hoping for a liver transplant (Independent 31st Oct 2010)

Sunday, 3 April 2011

I'm a 'Silent Witness' fan

I've got as far as I can translating my liver biopsy pathology report. I'm amazed how much information can be got from a tiny sliver about the length of your little fingernail (10mm).

First; what they didn't find. The biopsy ruled out 9 different things. Did that mean 9 tests on this sliver?

It ruled out 'mass cell death' - that's got to be good!

It ruled out in 3 different ways evidence of pre-malignancy or abnormal cells suggestive of HCC cancer.

It ruled out iron overload (common in liver disease)

It ruled out Wilson's disease and primary biliary cirrhosis, 2 other forms of liver disease

It ruled out choleastis which is a blockage of the bile ducts

Second; what it did find.

It found evidence of cirrhosis - no surprises there - and categorised it as 'moderate' disease progression, in most but not all sections.

went on to stage the cirrhosis by 4 different scores for inflammation.
I won't categorise the types of inflammation as they are gobbledygook, but think of it as 4 exam papers where the marks total 18, but you want a low not high score.
I score 2/4; 0/6; 2/4 and 3/4 which totalled 7/18.
My guess is that when you reach 18/18 your liver is a gonner.

It found evidence of bile duct destruction (you need bile to digest food) which is reflected in my 3 out of 4 score, above.

It found evidence that the liver was having trouble digesting fats.

The above 2 findings re-inforce my belief in a healthy, low fat, easy to digest diet.

It found 'patchy positive' evidence of hepatitis surface antigen HBsAg - this is the marker that says 'this person has or had hepatitis B'.

What will be significant, is if the tissue tells whether the hepatitis is ACTIVE or INACTIVE.
I've not fully understood this.

The good news is:- there is no evidence of a cell called a 'ground glass' cell (because of the way it looks). The presence of ground glass cells says WARNING: acute infection.

There is 'occasional' or 'patchy' evidence of various white blood cells. White blood cells are part of our immune system, and get busy when there are bugs invading us. Finding white blood cells in my liver might mean they are the remnants of Dads Army (see post 'War is Over') still knocking out any stragglers of hep B. Or it might mean they are attacking a new uprising. I dont know and it's on my list of questions for the hepatologist on Monday.

The good news (I think) is there is no evidence of something called 'granuloma' which is when the immune system encircles its enemy. Think John Wayne and a wagon train being encircled by indians.

Summary: Question to ask hepatologist - is the evidence of hep B in my liver cells suggestive of active or inactive hepatitis.

If the answer is inactive, good, I guess we continue to monitor.

If the answer is active, the next question will be 'what are we going to do about it before it makes the cirrhosis worse'.

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