Hep C Discussion Forum

Dzdayscomin · Senior Member

RE: Cirrhosis and Lab Results

wmlj1960 · Moderator

Is there any advantage to using triamterene rather than spiranolactone for a diuretic other than not causing gynecomastia?

I fit into my new bikini top just fine thanks to spiranolactone but I'm having an awkward fit issue with the bottoms...

My endoscopy showed no ruptured varicieal veins and my portal hypertension hasn't been mentioned since February so I guess I've escaped the donuts. And I hope it stays that way.

-- Edited by wmlj1960 on Wednesday 15th of October 2014 11:27:04 AM

Dzdayscomin · Senior Member

I quit spiranolactone and went on dyrenium(triamterene) and the gynecomastia subsided and has worked very well in combination with lasix to control my edema and acities. Still left with man boobs but that is a minor problem in my situation. ..but I'm now drawn to the victoria secret catalogs the wife gets looking at those lacy bras.....or maybe it's just the pretty girls ?IDK ......LOL

The donut around the naval is a gastric varicie from severe portal hypertension.

wmlj1960 · Moderator

Dzdayscomin wrote:
the donut around my naval is growing
______________________________
I'm still an idiot so hepetic encephalpthy is hard to determine.......

"donut"? The Aldactone (spironolactone) was enlarging my breast, and that made them sore to the touch for ~ the first 6 months, but the soreness is now gone other than at the tip of my nipples, But other than being a little larger than in January when I first started taking Aldactone I can't tell any difference, such as a "donut around my naval". What am I missing?

______________________________________________________

I agree Duane. My doctor seems to think my hepatic encephalopathy is an issue, but he didn't know how idiotic I was before he started treating me. biggrin

Isiscat2011 · Guru

So good to hear that your liver functions have improved and you are feeling better, Duane. Really amazing what getting rid of the HCV can do especially for those who have been experiencing the effects of it.

I also saw a Rheumatologist, primarily because I have very high positive ANA titers, and my PCP was trying to determine whether it was HCV related or something else. The Rheumatologist took lots of blood (13 viles to be exact) and was able to rule out an autoimmune disease as the cause with an 80% certainty. That's good enough for me; I think HCV can cause inflammation that looks like autoimmune disorder but best to see a Rheumatologist to rule that out. I wouldn't be surprised if some of your pain subsides somewhat as time goes by. In the meantime I'm just glad that you are able to get some relief with medication.

Rheumatologists also like to palpate your joints so if you are ticklish be warned.

PW: Sounds like you have decided on a Fibroscan and that seems like a wise decision to me. Since you are SVR4 you will probably be SVR12 soon and your liver will no longer be taking the HCV beating. Some insurance companies are probably already paying for Fibroscans and more will soon. At ~300 bucks a Fibroscan test is a good investment. Yes, there is a margin of error with Fibroscans, but there is with biopsies too. You can always have a biopsy if there are any pressing questions that need answers in the future.

OldenSlow · Senior Member

Gator Man wrote:
Beside a kPa measurement, I'm not sure of how much additional information can be gleaned from a Fibroscan report

Not much, I'd imagine. My understanding is that it's a useful tool for staging the degree of fibrosis, though a little wonky in the mid-ranges. For my purposes, it's nice having a non-invasive numerical value for monitoring potential fibrosis regression (or lack thereof) going forward.

Dzdayscomin · Senior Member

Well I thought that posting of my labs may help others see what an ESLD cirrhotics labs look like, if I were a dr. I may even say I have gone from decompensated to compensated..... because I just feel better.....1 yr ago I was in bad shape ! Now, almost all my labs are near normal ...well from my point of view..... My platelets and albumin are still low, my billy is high as is my INR, the donut around my naval is growing, but the acities and edema are down considerably, my skin is brittle and dusky to grayish in appearance, and I still suffer from muscle cramps if I exert myself to much...this doesn't not usually happen until later in the day when I am resting, I'm still an idiot so hepetic encephalpthy is hard to determine.......

If I don't take my pain meds I am uncomfortable when I eat or lying down,bending over, etc... and I still have terrible joint pain, for which I will be seeing a rheumatologist 10/30, I highly doubt there is anything they will do.

But other than that I am doing just great !

smile

Gator Man · Senior Member

OldenSlow wrote:
Well compensated cirrhotics can return normal blood values across the board, so I guess if you absatively, posolutely need to know a biopsy would be the definitive test.

Now that I am Hep C free, my blood values are all normal for the first time in 30 years. My doctor was insistent on a liver biopsy, and as frequently mentioned, it still is the 'gold standard' regarding the progression of inflammation and fibrosis. In my case, the results were "chronic inflammation with severe piecemeal necrosis consistent with chronic hepatitis and prominent septal fibrosis with some ares of nodule formation consistent with early evolving cirrhosis, Metavir classification A3,F4". There was also no evidence of neoplasm or granulomata.

Beside a kPa measurement, I'm not sure of how much additional information can be gleaned from a Fibroscan report, or how important having biopsy detail would be in a typical HCV case. Based in part on my biopsy result, the doctor was able to convince the insurance carrier that I was in grave need (his words) of immediate tx, which is how I got S/O off label approved last December. As an "early" (I know Malcolm disagrees with calling it early) evolving cirrhotic, would a Fibroscan score carry the same weight? I don't know what the answer is, but I went along with the medical advice and had an uneventful biopsy, unlike Huey's experience. Bottom line, if you trust your doctor and s/he thinks a biopsy is worth it, I would ask why and if satisfied with the response, accept their recommendation.

-- Edited by Gator Man on Monday 13th of October 2014 07:56:27 PM

patiently_waiting · Senior Member

Thanks for that info Duane. Matt, the Fibroscan sounds like the way to go if lab results don't tell me anything. I was just wondering if even that's necessary given all normal lab results. A biopsy doesn't make sense at all so I've already discarded that idea since I had it earlier this morning. If I'm at stage 3 my next step will be to use that baseline to compare to how it looks in the future...so I can gauge if it's improving over time.

EDIT: I hadn't seen the last two posts before I clicked submit...I think I have my answer: Fibroscan.

-- Edited by patiently_waiting on Monday 13th of October 2014 06:43:41 PM

Dzdayscomin · Senior Member

Name Standard Range	9/5/12	10/31/12	1/28/13	6/18/13	7/11/13	9/5/13	10/4/13	12/16/13	3/7/14	6/6/14	9/5/14	9/24/14
A/G RATIO 1.0-2.0			0.6	0.7	0.8	0.7	0.7	0.8	0.7	0.9	0.9	0.9
ALBUMIN 3.5-5.2 g/dL			2.5	2.8	2.9	2.7	2.8	2.8	2.5	3.0	3.2	3.1
ALK PHOSPHATASE 50-136 IU/L			276	246	168	199	157	176	252	252	236	198
ALT (SGPT) 8-45 IU/L			94	114	101	255	232	114	111	36	33	30
AST (SGOT) 2-40 IU/L			114	150	132	307	258	151	139	52	37	47
BILIRUBIN,DIRECT 0.1-0.5 mg/dL	1.5	1.0		1.3		1.4	1.9	1.2	1.1	0.9	0.9	0.7
BILIRUBIN,INDIRECT 0.2-0.8 mg/dL		0.8		1.1		1.2	1.4	1.1	0.9	0.9	1.1	1.1
BILIRUBIN,TOTAL 0.2-1.2 mg/dL			1.9	2.4	2.7	2.6	3.3	2.3	2.0	1.8	2.0	1.8
GLOBULIN 2.0-3.7 g/dL			3.9	3.8	3.8	4.1	4.1	3.4	3.5	3.3	3.4	3.3
PROTEIN,TOTAL 6.0-8.0 g/dL			6.4	6.6	6.7	6.8	6.9	6.2	6.0	6.3	6.6	6.4

Name Standard Range

an you tell when I started the S/O tx

-- Edited by Dzdayscomin on Monday 13th of October 2014 05:58:30 PM

-- Edited by Dzdayscomin on Monday 13th of October 2014 05:58:50 PM

OldenSlow · Senior Member

Well compensated cirrhotics can return normal blood values across the board, so I guess if you absatively, posolutely need to know a biopsy would be the definitive test. That said, I agree with Matt about the FibroScan. Quick, non-invasive and accurate, particularly on the higher and lower ends. My score at 5 months post-tx was 30 kps, which is indicative of cirrhosis w/ portal hypertension (already knew that wink ) and we'll do another a year from now to see how things look. Blood value-wise, my always low platetlets and mildly elevated ALP suggest cirrhosis. All else normal. Ultrasounds always show the enlarged spleen, also suggestive (though it's decreased in size since beginning tx).

Matt Chris · Guru

Hey PW

I can understand your wanting to know more about your possible Liver condition. I would guess because you have passed that first EOT plus 4 weeks your doctor feels that is not the primary importance. If you feel compelled to want to know I would suggest getting a Fibroscan, its very accurate and a whole lot less expensive and your in and out in minutes with no possible complications.

The Fibroscan machines are becoming more available, its a good choice.

matt

-- Edited by Matt Chris on Monday 13th of October 2014 05:16:26 PM

Dzdayscomin · Senior Member

Hmmm....I have never had a biopsy, one way i think could be looking at your MELD score Billirubin, Creatinine, and INR

Cirrhosis presents itself in some common ways and some that are pretty much patient specific.

Here are some I have....

Low platelets or Thrombocytopenia in the 40 to 60 range

Portal Hypertension

Varicies

Acities can be mild in compensated stage

Splenomegaly

hepetic encephalpathy before HCV tx

patiently_waiting · Senior Member

I have done some poking around about this on the web but haven't found anything conclusive. I'm wondering if Malcolm or other knowledgeable folks on this site know the answer to this. I'm wondering what a person's lab results for all the typical tests one would get for HCV or other liver disease would usually look like for someone with cirrhosis. Aren't there typically signs with lab results that would seem to at least partially indicate cirrhosis? More importantly for me at least, if someone has consistently normal results on all lab results (ALT, AST, blah blah blah) wouldn't that be a fairly strong indicator that cirrhosis is not present? I'm trying to decide whether I want a biopsy. All my labs are normal and for the most part have always been normal with the exception of just before I most recently started treatment and a few times years ago.

I understand the only way to get a true picture of the condition of your liver is with a biopsy (and fibroscan following that, but it's not as accurate), but this is a separate question. It would seem to me that if a person had stage 3 or 4 cirrhosis there would at least be *one* result that would be coming back as abnormal, no?

I did find this but it's a small study and from 1998:

Objective: A liver biopsy is necessary to grade and stage chronic hepatitis C virus (HCV) infection. In a previous study of patients with nonalcoholic liver disease, an aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio >1 suggested cirrhosis. We sought to examine the value of the AST/ALT ratio in distinguishing cirrhotic patients with chronic HCV infection from noncirrhotic patients and to correlate the ratio with the grade and stage of hepatitis and other biochemical indices. Methods: We retrospectively studied 139 patients with chronic HCV infection. Routine biochemical indices were determined, and the histological grade of necroinflammatory activity and the stage of fibrosis of the liver biopsy specimens were scored. Results: The mean AST/ALT ratio in the cirrhotic patients (n = 47) was higher than in the noncirrhotic patients (n = 92) (1.06 ± 0.06 vs 0.60 ± 0.09; p < 0.001). A ratio 1 had 100% specificity and positive predictive value in distinguishing cirrhotic from noncirrhotic patients, with a 53.2% sensitivity and 80.7% negative predictive value. The ratio correlated positively with the stage of fibrosis but not with the grade of activity or other indices. Of the cirrhotic patients, 17% had no clinical or biochemical features suggestive of chronic liver disease except for an AST/ALT ratio 1. Conclusion: The AST/ALT ratio is a dependable marker of fibrosis stage and cirrhosis in patients with chronic HCV infection.

Also found this:

The ALT is thought to be the most cost-effective screening test for identifying metabolic or drug-induced hepatic injury, but like other liver function tests, it is of limited use in predicting degree of inflammation and of no use in estimating severity of fibrosis.15 One study found that a platelet count of less than 160 K per mm3has a sensitivity of 80 percent for detecting cirrhosis in patients with chronic hepatitis C.16

15. Dufour DR, Lott JA, Nolte FS, Gretch DR, Koff RS, Seeff LB. Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clin Chem. 2000;46:205068.

16. Pilette C, Oberti F, Aube C, Rousselet MC, Bedossa P, Gallois Y, et al. Non-invasive diagnosis of esophageal varices in chronic liver diseases. J Hepatol. 1999;31:86773.

My platelets are 146 so I guess that could be one red flag, even though that's considered within the normal range.

-- Edited by patiently_waiting on Monday 13th of October 2014 04:55:49 PM

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