Re: HCV with Cirrhosis and Ascities, I need advice...

From: tiresias (me_at_mine.com)
Date: 02/04/05 

Date: Fri, 04 Feb 2005 17:23:26 GMT

Hi Khalid,

I have well-establised hcv, cirrhosis, enlarged spleen. portal
hypertension and have had a couple of goes at the combo tx, last time
Nov '04 for only three weeks stopped because of ensuing liver
decompensation.

 From my knoweldge and looking at the readings and reports below I will
give you my opinion, note again, my opinion, on your questions.

ka5880@hotmail.com wrote:
> Dear All,
>
> Here is a summary report of my brother's case with Hepatitis C,
> Cirrhosis and Ascites. For anyone out there who can advice what to do
> and tell us how this will develop next and how to act upon it, please
> tell us and help.. Thanks.
>
> Khalid
>
> PS. We didn't want to go for a biopsy because many say it's dangerous
> for patients with Cirrhosis and Ascites.
>
> Questions:
> - Is it true that patients with HCV, Cirrhosis and Ascites will
> eventually need a liver transplant because there is no cure for them
> yet espceially at an advanced level like my brother's?
T---Correct

> - Is it likely that this will develop into liver cancer, and hence it's
> better to have a liver transplant in order to prevent cancer spreading
> to the rest of the body?
T---it is not unlikely that HCC will develop. HCC from cirrhosis is more
likely to be localised to the liver and not spread rapidly to other
partss of the body. Tends to be slow growing but with cirrhotic livers
any more loss of function is not handled well. HCC does not stop a liver
transplant happening but the lesions need to be of a certain limited
number and size in order for a transplant to be viable.

Your brother ought to have had an evaluation for a liver transplant in
his condition having decompensated cirrhosis with ascites and a bleed.
In my opinion he or you need to ask about this before he gets too ill to
be considered as a viable liver transplant recipient.

> ===+++++++++++=============================================
> MRI, Liver with contrast enhancement (19 June 2004)
>
> - Ascites.
> - Liver - Small, nodular outline, consistent with cirrhosis.
> - Mild dilatation of portal vein.
> - Splenic vein normal in diameter, mild splenomegaly.
> - Solitary ill-defined, infiltrative lesion, Segment IVB in the
> gallbladder bed, extending till the segmental portal triad.
> - IHBR normal.
> - GB - normal distension, normal wall thickness; pericholecystic
> fluid secondary to ascites.
> - Kidney normal, (Rt renal parapelvic cyst).
> - Retroperitoneum normal.
>
> Doctor's impression:
> Cirrhosis with mild portal HT.
> Segment IVB infiltrative mass lesion. ? HCC.
> ADV: USG biopsy of mass.
>
> =======================================================
>
> Medical Report: 18 January 2005
>
> FINAL DIAGNOSES
> - Chronic Hepatitis C Infection with Cirrhosis
> Failed to Respond with Combination IFN/RIBAVIRIN therapy
>
> PRESENTING HISTORY
> This patient has been on follow up for last 7 - 8 years for his chronic
> hepatitis C. He had infection with low viral load (Geno Type not
> known). There was history of blood transfusion in 1980 and 1982.
> Clinically he complained of fatigue and dyspepsia. Investigations in
> 2001 showed Grade 1 - 2 varices and a well compensated Child's Class A
> Cirrhosis. After careful consideration he was started on treatment with
> Interferon Alpha and Ribavarin combination therapy, which was
> complicated by recurrent Thrombocytopenia and Neutropenia requiring
> frequent dosage adjustment. He did not achieve early viral response;
> however, there was a reduction of the viral load at this point of time.
> Hence, the treatment was continued for a few more months (total 6
> months). He failed to respond to this therapy. Since then he has been
> on a surveillance protocol for HCC. Recently he has been complaining of
> pedal oedema, mild distension of abdomen (ascites) and severe fatigue.
> There is one day recent history of GI bleed for which 3-4 sessions of
> EVL/ESD was done with good response. He is on Beta Blockers for
> secondary prevention of GI bleed.
>
> INVESTIGATIONS
> 21/10/2001 09:16
> ANA.Ab Negative
>
> 27/10/2001 10:17
> HCV RNA Viral load: 31,300 IU/mL.
>
> 02/06/2002 13:58
> Alpha Fetoprote 41.7 ug/L (Less than 15)
>
> 26/10/2002 12:15
> HCV-VIRAL LOAD 16,300 IU/mL
>
> 16/02/2003 16:55
> HCV RNA VIRAL LOAD: 407,000 IU/ML
>
> 26/12/2003 13:33
> Ammonia 51 umol/L (12-47)
>
> 18/04/2004 10:29
> Free T4 14.1 pmol/L (8.4 - 22.6)
> Thyroid Stimula 1.058 mIU/L (0.03 - 4.29)
>
> 20/10/2004 11:35
> Alpha Fetoprote 32.4 ug/L (Less than 15)
>
> 28/12/2004 21:36
> Haemoglobin 11.4 g/dl (14 - 18.1)
> Platelet count 76 xl0pwr9/l (140 - 450)
> WBC 5.9 xlOpwr9/1 (3.6 - 11.5)
> Neutrophils 2.1 x10pwr9/l (1.7 - 7.8)
>
> 28/12/2004 21:46
> Urea 1.7 mmol/L (2.5 - 7.5)
> Total Bilirubin 3.4 umol/L (3 - 17)
> Creatinine 72 umol/L (60 - 120)
> Total Protein 62 g/L (58 - 78)
> Albumin 21 g/L (35 - 50)
> ALT (SGPT) 11 IU/L (10 - 60)
> Alkaline Phosph 143 IU/L (36 - 104)
>
> INVESTIGATIONS (CONT...)
> - Ultrasound & CT Scan showed evidence of Cirrhotic Liver but no mass
> lesion or portal vein thrombosis.
>
> TREATMENT & PROGRESS:
> - This patient was well compensated in 2001 but failed to respond to
> anti viral therapy. He has developed progression of his liver disease
> with decompensation since late 2003. He is on HCC surveillance and his
> AFP is around 40 and has been steady at this level for the last 2
> years. Ultrasound and CT do not show HCC. His present management
> consist of diuretics, Beta Blockers, Variceal Eradication and yearly
> surveillance Endoscopy.
>
> RECOMMENDATION
> - He is not a fit candidate for PEG Interferone due to significant
> cytopenia and decompensated liver disease.
>
> =============== END of reports ====================
>

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