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Cirrhosis, Should I get a second opinion?

I had an abdominal ultrasound that said I had cirrhosis.  A subsequent Fibroscan, MRI and MR elastography were excellent as were all my labs.  I had blood in my urine once, diarrhea 3 times that cleared up on its own, and a couple of dozen cherry angiomas on my torso.  I’ve been told by my gastro that the ultrasound was faulty and my symtoms can all be attributed to other things.  Thoughts?
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683231 tn?1467323017
From webmd

Cirrhosis doesn't happen overnight. You get damage to your liver over a long period of time. The most common things that raise your odds for cirrhosis are:

Heavy drinking due to alcohol addiction
Obesity, which raises your chances of conditions that lead to cirrhosis
A long-term hepatitis B or hepatitis C infection

Conditions that can lead to cirrhosis include:

Cystic fibrosis
Diseases that make it hard for your body to process sugars
Too much iron buildup in your body
Wilson's disease, where too much copper is stored in the liver
Autoimmune diseases that cause your body to attack liver cells
Blockage of the bile duct, which carries digestive enzymes from your liver into the intestines
Certain genetic digestive disorders
Some infections, including syphilis and brucellosis
Bad reactions to certain medications
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1 Comments
I’ve had 3 glasses of wine a day for 20 years, so I was worried about cirrhosis.
683231 tn?1467323017
While an ultrasound can show indications of cirrhosis it is not the first means to diagnose cirrhosis more so to corroborate a cirrhosis diagnosis and monitor for liver cancer. Tests to diagnose cirrhosis include the Fibroscan test which uses a machine similar to an ultrasound to estimate liver stiffness, a blood test called fibrosure, and liver biopsy.

Diarrhea is not a symptom of cirrhosis. Neither is blood in urine.

What causes cherry angiomas? The exact cause of red moles is unknown, but there may be a genetic factor that makes certain people more likely to get them. They've also been linked to pregnancy, exposure to chemicals, certain medical conditions, and climate.

Do you have a reason to suspect you have cirrhosis? Have you been a heavy drinker for many years or do you have chronic hepatitis B or hepatitis C? Do you have fatty liver disease or some other illness that attacks the liver?

Lacking any reason to suspect cirrhosis I would defer to the judgement and knowledge of your gastroenterologist.
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3 glasses of wine a day for 20 years had me worried about cirrhosis.  I had lost some weight and had lack of appetite, nausea and vomiting that all went away when I started on a medication that causes weight gain.  My husband, my gastro and I attribute these symptoms to stress and anxiety about my health.  Could the blood in my urine be bilirubin?  All my blood tests have been excellent.
The cherry angiomas I was afraid were the “stigmata of cirrhosis,” a cutaneous manifestation of the disease caused by the livers challenge processing estrogen.
Cherry angiomas have multiple causes many are benign. Aging skin can also cause them.

Blood in urine is associated with kidney disease. Bilirubin causes a darkening of urine a symptom of advancing liver disease excess bilirubin in urine would look like cola color. Also high bilirubin would be evidenced in blood tests.

That is a higher than recommended intake of alcohol for a women. For health you should probably try to reduce your intake to not more than the recommended level. Per the US CDC “ The Dietary Guidelines also recommend that if alcohol is consumed, it should be in moderation—up to 1 drink per day for women and up to 2 drinks per day for men.”

Just to add, I’ve been living with liver cirrhosis since January 2008. My bilirubin has always been normal. My cirrhosis was caused by being infected with hepatitis c for about 37 years.

My liver ultrasounds day things like coesened echo texture consistent with cirrhosis. What did your ultrasound report say about cirrhosis? Are your liver enzymes elevated (ALT and AST)? Are you still drinking to excess?

Again, I would trust your doctors opinion but you can always get a second opinion for your own peace of mind.
Red moles, or cherry angiomas, are common skin growths that can develop on most areas of your body. They're also known as senile angiomas or Campbell de Morgan spots. They're usually found on people aged 30 and older. The collection of small blood vessels inside a cherry angioma give them a reddish appearance.
You’re very knowledgeable!  When my urine was dark I assumed it was blood.  Could have been bilirubin.  No blood test showed bilirubin problems.  My liver enzymes showed a bit of a change which started all the worry.  They quickly righted themselves and all other labs and bloodwork have been stellar.  The abdominal ultrasound said f3 f4.  A CT of abdominal and pelvis, a Fibroscan, an MRI and a MR elastography have all been great.  I’ve been pushing for a biopsy because of the liver enzyme change and the abdominal ultrasound.  BTW I haven’t had a drink since Nov. 25, 2019.  Scared straight.
An ultrasound is a picture only. The doctor reviews the images and describes what they see like the coarse echotexture comment that I see on my report . A Fibroscan is similar to an ultrasound except it produces a sort of thump that is used to estimate liver stiffness. There are five possible fibrosis scores (F0: no scarring (no fibrosis); F1: minimal scarring ; F2: scarring has occurred and extends outside the liver area (significant fibrosis); F3: fibrosis spreading and forming bridges with other fibrotic liver areas (severe fibrosis); F4: cirrhosis or advanced scarring ). If you were given a F score you may have had a Fibroscan not an ultrasound.

My Fibroscan score is F4 has been since January 2008.

Dark urine could simply be needing to drink more water. Did your urine look like cola?

But in any event if your bilirubin is normal you do not have elevated bilirubin.

You said you had some elevated liver enzymes. Which ones? Were they outside of normal range?

Doctors are trying to avoid the invasive liver biopsy now that there are non invasive methods like Fibroscan and Fibrosure. A liver biopsy involves about a half day in the hospital and requires you to have a driver to take you  home. Usually you are sedated while the insert a large needle between the ribs on your lower right side. After the procedure you are to rest until they are sure you don’t have a risk of internal bleeding. Risks are infection, internal bleeding and complications of anesthesia. I’ve had at least 4 liver biopsies personally not a fan.

As far as Fibroscan if you have eaten prior to the exam or are over weight this  can make your results less accurate also Fibroscan is operator  skill dependent. The Fibroscan is most accurate at determining either no damage or cirrhosis (F4) it is less accurate at mid range levels of damage.

Congrats on stopping drinking. If you did have some liver damage simply by stopping drinking you can stop any further damage from alcohol and very possibly reduce any damage that may have occurred before you stopped.

Yeah I’ve been reading a lot over the years I have been aware of my hep c and later cirrhosis. I learned I had hep c in 1990 when I donated blood and had out of normal range liver enzymes. So I’ve had 30 years of reading about liver disease.

Best wishes to you
I also had beige poo for months which overnight switched to dark brown.  Do my symptoms, bad ultrasound, and slightly off enzymes one time add up to cirrhosis or am I paranoid?  
Trust your doctor is my best advice.
https://www.webmd.com/digestive-disorders/what-do-different-poop-colors-mean
Have you asked your doctor’s opinion about your beige stools?
You are kind to share all that you have learned.  I obviously need to ask my drs. the questions you asked me about my liver enzymes.  They were not concerned.  I’ll educate myself.  The “abdominal ultrasound elastography says nothing negative except that it has a median liver stiffness that corresponds to f3 f4.  This was followed up with a FibroScan which was 3.7 or f0.  I wish my memory wasn’t clouded by fear.  My urine, the one time, was what I would call dark red.  Could have been cola colored.  But again, no bilirubin problems in blood test.  You have an amazing attitude.  I wish you all the best.  I’m sorry you’ve had to go through so very much.  Life is anything but fair.
abdominal ultrasound elastography  Is a Fibroscan

https://medlineplus.gov/lab-tests/elastography/

Cola colored looks very much like a coke a cola

“ Despite its alarming appearance, red urine isn't necessarily serious. Red or pink urine can be caused by: Blood. Factors that can cause urinary blood (hematuria) include urinary tract infections, an enlarged prostate, cancerous and noncancerous tumors, kidney cysts, long-distance running, and kidney or bladder stones.”


https://www.mayoclinic.org/diseases-conditions/urine-color/symptoms-causes/syc-20367333
Maybe the other test was a fibrosure blood test?
I have the written report for an abdominal ultrasound with duplex scanning.  All was well.  A hepatic elastography was performed as well. The median LS value was 3,51 m/s which the report says corresponds to METAVIR  f3 f4 high risk of clinically significant fibrosis.   The equipment was a Siemens Acuson S 2000.  Acoustic Radiation Force Impulse Imaging (virtual touch tissue quantification) 4 Vector Transducer.  This test was ordered by my PCP.  My gastro sent me for a FibroScan which I was told was a more definitive test.  It was 3,7 or f0.  
I told my gastro about my light poo.  Thanks for the medical site referral.  It says light colored poo could mean liver problems because of lack of bile.  My gastro thought it was likely something I ate though I explained it was going on for months.  It’s made a change for darker which I hope is a sign that everything is fine and not evidence that my liver is struggling.
Here is a link to a web site I got a lot of information from when I wes first starting to learn about liver stuff. Lots of good information there

https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/cirrhosis/
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