Liver disease

[Guest guest]

My personal liver disease problems: Had elevated enzymes for many months ...

almost a year. Was getting bloodwork done every 3 months to keep an eye on the

levels. This latest bloodwork in May was perfect ... everything totally normal.

Also had liver/pancreas ultrasound done a few months ago and it was normal. So

.... ????? Just a Lyme thing for me with no other causes

as far as we can figure. I haven't been on any abx for years so it wasn't

caused by that. I go back in Aug. for one more set of lab work and if

everything is still normal, the Dr. will release me. :-)

Don't know if that little bit of info will help anyone or not, but there it is.

Jean

(In HOT, HUMID south TX)

[Guest guest]

THis is true that perdnisone give you hot flashes? WOW....I didn't realize that! Now I know I am not going mad! Thanks! debby

[ ] Liver disease

Hi,Beth! I have seen Dr. Henley, at the U, he is a very nice and caring doctor,he is Professor of internal medicine,Division of Gastroenterology,Department of internal medicine. I see him as the decision maker in my treatments, But also see my hepatoligist here in mostly. I know that I have peri-portal fibrosis, Which I guess is a fine line between that and cirrohsis, I take 100mg. of Imuran, and 5mg. of prednisone,They just started cutting the prednisone as of December of this last year,But my levels were going up and down they started me out with 50mg. of imuran, So in february they started me at 100mg. and I started responding quite well. I suffer from the fatigue, sore liver, hot flashes and etc..... like everyone else, which I know is side effects of the pred. But it is a life saver also! So I guess along with everyone else we suffer the cosequences, and put our faith in god. Please continue to contact me back, great hearing from you,Gloria

[Guest guest]

I get the hot flashes too... have always been a person who was cold, so it's been an adjustment. I didn't wear sweaters, turtlenecks or sweatshirts last winter....and I live in Michigan!

Has anyone noticed that their teeth are more sensitive to cold as a result of either the Medrol (Prednisone) or the Imuran? Ever since I've been diagnosed, I've had sensitive teeth while drinking a cold glass of milk, a peach/plum from the fridge, etc. I've never had a problem with it before... maybe it's something else, but just wondered if anyone else has noticed this....

thanks for your help,

Beth Walters, Portage, MI

p.s. not really complaining... I know there are worse side effects and the meds are saving my life.... have to keep reminding myself of that as I have the hot flashes and as I step on the scale... :-(

[ ] Liver disease

Hi,Beth! I have seen Dr. Henley, at the U, he is a very nice and caring doctor,he is Professor of internal medicine,Division of Gastroenterology,Department of internal medicine. I see him as the decision maker in my treatments, But also see my hepatoligist here in mostly. I know that I have peri-portal fibrosis, Which I guess is a fine line between that and cirrohsis, I take 100mg. of Imuran, and 5mg. of prednisone,They just started cutting the prednisone as of December of this last year,But my levels were going up and down they started me out with 50mg. of imuran, So in february they started me at 100mg. and I started responding quite well. I suffer from the fatigue, sore liver, hot flashes and etc..... like everyone else, which I know is side effects of the pred. But it is a life saver also! So I guess along with everyone else we suffer the cosequences, and put our faith in god. Please continue to contact me back, great hearing from you,Gloria

[Guest guest]

, welcome. You will find lots of people here who can give you much information. Good luck. When were you dx with AIH?

Debby

[ ] liver disease

Hi. I am 39 and was diagonsised in 1998. I would very much like to join your support group

MSN 8 with e-mail virus protection service: 2 months FREE*

[Guest guest]

Hi !

I am 38 and Dx in 1999. Welcome to our little family! If you are

any thing like I was, you are so greatful to have found this place.

I only stumbled upon it a few short months ago, and it has all ready

given me such great inspiration. They say this disease is rare,

though you wouldn't know that by how many are here. But it is rare

enough for it to be difficult to find a friend locally to you with

the same disease, making you feel very lonely. With no one around

you going through it, you tend to question yourself after a while if

all that is happening to you is the disease, or if you are just going

crazy. Well we all here can attest you are not crazy! Any symptoms

you may be going through, guarenteed most here have been through it

too. And every one has great suggestions and support on dealing with

them. So my hope to you is you find the great strength that I have

found from this group. So come on board and tell us your story! We

are all ears, well eyes any way.

Welcome!

CArole K

>

[Guest guest]

Joanne ...... This was a very excellent post .... I for one thank you

for sending it.

I'll put it in my file.

BTW.... I also want to thank you for all the great work you have done as

modeator.

My pal Joan has big shoes to fill. I hope you get to better health and

soon. I shall pray that it happens.

Bless you

love jerry

http://www.mcw.edu/gastro/liver_disease.html

What are liver function blood tests and what do they mean?Liver function tests are tests that reflect various types of damage to the liver and bile ducts. A typical panel involves transaminases (SGPT, SGOT), alkaline phosphatase, and a bilirubin. Diseases that affect the liver are manifested by elevated transaminases while diseases involving the bile ducts are manifested by an increased alkaline phosphatase. Both types of diseases can raise the bilirubin. Elevation of any of these tests reflects damage and requires further evaluation.

Are all liver diseases the same?All liver diseases are not the same. There are countless types of liver diseases, which can progress at different rates. While some tend to have a harmless and less aggressive course, others can progress to serious liver disease including liver failure and the need for liver transplantation. Laboratory tests and liver biopsy are helpful, not only in determining the cause of the liver damage, but also the severity.

What are the most common adult liver diseases? Common liver diseases include viral hepatitis A, B, C, D, E, and G although chronic hepatitis occurs only as a result of hepatitis B and C.

Fatty liver disease, also known as NASH (nonalcholoic steatohepatitis) or NAFLD (nonalcoholic fatty liver disease) is the most common liver disorder in the United States. Common risk factors for this disease include obesity, diabetes mellitus and elevated cholesterol or triglycerides. It is felt that up to 20% of the United States population may have a form of fatty liver disease. In a smaller percentage the disease can progress to advanced stages including cirrhosis. Treatment has focused on correcting the underlying factors such as weight reduction, control of diabetes and cholesterol. There are some newer therapies such as ursodeoxycholic acid, which have been shown, in several studies, to decrease the inflammation associated with fatty liver. There is extensive ongoing research regarding newer therapies for fatty liver.

Alcoholic liver disease continues to be one of the leading causes of liver damage. Alcohol is a toxin that when ingested in significant quantities directly damages the liver cells. Much has been learned about the method by which alcohol is toxic to the liver but alcohol abstinence remains the keystone of therapy. Anyone with chronic liver disease of any cause should completely avoid alcohol.

Primary biliary cirrhosis (PBC) is a disorder that affects the small bile ducts within the liver, typically in middle age women. Patients tend to present with complaints of itching because of the inability of the bile to drain through the damaged bile ducts. The disease also has other systemic complications including bone disease, increased risk of fluid retention and gastrointestinal bleeding. The cause of primary biliary cirrhosis appears to be a disorder of the immune system whereby the bile ducts are attacked aggressively by antibodies, the most common of which is the antimitochondrial antibody. A simple blood test is helpful in diagnosing this condition. While there is no treatment, there is evidence that ursodeoxycholic acid is effective therapy at slowing down the progression of this disease. Unfortunately, many patients progress to end-stage liver disease and the need for a liver transplantation.

Primary sclerosing cholangitis (PSC) is a condition similar to primary biliary cirrhosis, however, both the large and small bile ducts are involved in this condition. There is no female predominance in this condition and in addition, there are no blood markers that aid in diagnosis. The majority of patients afflicted with PSC have concomitant inflammatory bowel disease (ulcerative colitis, Crohn's disease). While both of these conditions are found in combination, the severity of one does not correlate with the other. There is no effective medical therapy for primary sclerosing cholangitis and many of the patients progress to cirrhosis and are at increased risk for bile duct cancer (cholangiocarcinoma). Liver transplantation offers the only effective long-term therapy in patients with advanced disease.

Autoimmune hepatitis is a condition where antibodies are produced that attack the liver cells. It is typically a disease of young to middle aged women although elderly patients are increasingly being diagnosed with this condition. The diagnosis is supported by a typical biochemical pattern as well as the presence of antinuclear antibodies and anti-smooth muscle antibodies in the blood. The patient may have symptoms of fatigue, malaise, jaundice and blood test that reflect damage to the liver. Therapy consists of immunosuppressents in particular, prednisone and Azathiaprine. When this condition is diagnosed at an early stage, therapy is quite effective, however patients with advanced disease need to considered for liver transplantation.

Heredity hemochromatosis is a condition where the gene responsible for helping the body rid iron from the body is nonfunctional and, as a result, iron accumulates in various organs in the body, including the liver. When this occurs the liver can frequently become cirrhotic and is also at an increase risk for liver cancer. Heredity hemochromatosis is found in 1 out of every 250 Caucasian patients in the United States. Diagnosis can easily be confirmed by a simple blood test to evaluate the amount of iron in the body as well as a genetic test, which detects whether the gene responsible for this condition is present. Therapy aims at removing the excess iron from the blood and is typically done by phlebotomy or blood removal. More advanced cases require liver transplantation.

's disease is a disorder that occurs from a defective gene that causes copper accumulation in the body including various parts of the brain. Patients frequently present as "underachievers" and with evidence of liver failure. While not as common as hereditary hemochromatosis, 's disease when diagnosed early can be effectively treated. More advanced cases of 's disease require liver transplantation.

How safe is a liver biopsy, and what are the potential complications? The liver biopsy is a safe procedure when standard precautions are taken. The risk of bleeding that may require transfusion is less than 2% and the risk to adjacent organs is also in the range of 2%. The procedure is typically done by localizing an area in the right upper quadrant immediately on top of the liver. The area is cleaned with a sterile solution and a local anesthetic is applied. Once the area has been anesthetized a slightly larger needle is passed through this area rapidly into the liver and then withdrawn. The sample is available immediately and is sent to pathology for microscopic examination. The patient is typically monitored for several hours in the hospital but is discharged to home, if there are no complications and normal activity can be resumed by the next day. No sutures are necessary and no scar forms.

What is cirrhosis and what causes it?Cirrhosis is irreversible scarring of the liver. There are countless causes and severities of cirrhosis. Cirrhosis can be diagnosed on a liver biopsy and occasionally on an ultrasound or CT scan of the abdomen. Laboratory testing usually suggests advanced liver disease including cirrhosis.

What are the complications of cirrhosis? The complications of cirrhosis include bleeding from the gastrointestinal tract as accessory blood vessels form in the region of the liver because of damage. Fluid accumulation in the abdomen, known as ascites, is also quite common and there is a possibility that this fluid may become infected presenting as a condition known as spontaneous bacterial peritonitis. Because the liver filters waste products from the bloodstream, a condition known as hepatic encephalopathy can develop if the liver is injured to a degree where it cannot remove these waste products from the body. The complication of this is a mental slowing or confusion, which is reversible and can easily be treated successfully with medications if properly diagnosed.

How can liver cancer be diagnosed, and what are the treatment options?Liver cancer typically occurs in the setting of advanced liver disease such as cirrhosis and can manifest with symptoms including abdominal pain, ascites, encephalopathy or worsening jaundice. Alpha fetoprotein a blood test that is elevated in up to 60% of patients with liver cancer. It is commonly used to monitor for the development of this complication. Radiographic studies of the abdomen including an ultrasound and CT scan represent the best test to diagnose cancers, as they will identify a mass that is clearly different from the surrounding liver tissue.

Treatment options depend on the location of the tumor as well as the size. Traditional systemic chemotherapy and radiation therapy are not effective in liver cancer. Treatments currently in use include; radio-frequency ablation where a probe is used to burn cancer cells, cryosurgery where a probe is used to freeze malignant cells, alcohol injection where a small needle is introduced into the tumor and 100% alcohol is injected to kill many of the cancer cells and arterial chemoembolization where chemotherapy is introduced into the blood vessel that supply the tumor. In addition, during arterial chemoembolization the blood supply to the tumor can be reduced, thereby decreasing the tumor's ability to grow, as it cannot obtain oxygen. Liver transplatation also offers the chance for a cure in patients with small tumors (less that 5 cm in diameter).

How common is liver transplantation, what are the common indications and what are the results? There are approximately 4500 liver transplants performed annually in the United States. Unfortunately, there are over 17,000 patients on waiting lists. The most common indications at this time include viral hepatitis C, previous alcohol use and biliary disease such as primary sclerosing cholangitis and primary biliary cirrhosis. Results continue to improve and there is over 90% survival at 1 year. Five-year survival rate for most transplantation indications are in the range of 75-85%.

Can a portion of a liver be donated to a patient with cirrhosis requiring liver transplantation?Live donor transplantation has become much more common in the United States over the past several years. This includes a healthy individual donating the right lobe of his liver, which represents approximately 60% of his liver mass to a patient who is in need of a liver transplant. Both the donor's remaining liver and recipients liver will grow in a period of 1-02 months and return to normal size. Long-term results are encouraging and this offers alternative options, as there is a significant organ shortage, which the transplant community faces. Extensive evaluation of both the donor and the recipient is necessary to ensure that there are no major contraindications in either patient.

Should I avoid certain mediations if I have liver disease?The liver is one of the major organs responsible for metabolizing and eliminating medications from the body. There are over 1000 medications, which are potentially toxic or can cause injury to the liver. Certain medications are more harmful in specific conditions. Before starting any medication, including over the counter medications, patients need to consult their physicians to discuss potential side effects.

Diet and the liver, what is the role?Diet clearly is necessary for health maintenance and individuals with poor dietary habits are at increased risk for infections as well as slowed recovery from illnesses, including liver disease. Several liver disorders such as fatty liver, hemochromatosis and 's disease require specific dietary modifications such as avoiding high fat foods for fatty liver, foods rich in iron content for hereditary hemochromatosis and foods rich in copper in 's disease.

[Guest guest]

Hi everyone,

I don't post very often, but I read this digest every day. I was

diagnoised with RA in March 2004. I have been on methatrexate (2

yrs.), plaquneil (8 mths.),arava (3 mths), humaria (4 mths) and now

Orencia (5 mths. for now).

My liver enzymes started being elevated in Feb. 2005, they have

remained elevated. My GP sent me to a gastroenterologist about 8

mths ago, he just watched to see if they went higher. They haven't

but they don't come down either. In Jan. 2006 the GI dr. did a

complete liver panel lab work up. The lab work indicated auto

immune hepitis. He then ordered a liver biospy (painful). This

biospy showed inflamation and scarring of the liver. I do not and

have never drunk acohol of any kind (#1 cause of liver scarring).

Now he isn't sure what it could be, auto immune hepitis of NASH. On

a scale of 1 to 4 my inflamation and scarring were rated a 4 for

both. He is now referring me to a Liver specialist at Duke

University Hosp. here in NC. Has anyone else had any liver problems?

Needless to say I am very bummed right now. I homeschool my 9 year

old special needs child and I don't need this to deal with now.

Thanks for all your input and support.