stages and grades in cirhossis

[fanofhawks]

I know about the 4 stages of cirhossis, but I have seen something about "grades" too.  i.e. - stage 4, grade 3 etc.  

What does the grade mean?

[fanofhawks]

Oops!  I meant that she lives in Brevard Co., Fl - NOT Broward Co.!  I always get the two mixed up.  

[fanofhawks]

TY for clearing this up for me.  My sister has cirrhosis and was diagnosed 5 yrs. ago.  Also with ESLD and a decompensated liver.  She has never been under the care of a liver doctor.  She is still seeing a gastro-enterologist.  She has been suffering for a few weeks with intense itching on her legs and arms that keep her up all night.  She claimed that she was having an allergic reaction to tomato sauce and chocolate.  I told her to see her doctor because I know it is a symptom of her liver disease.  She said she did and the doctor is treating the itchiness with a topical cream and benedryl.  My sister told me that her GE refers to a liver specialist if she needs to.  My sister has been seeing this same GE since she was discharged from her near-death experience 5 yrs. ago.  Is her GE remiss in NOT referring my sister to a liver doctor at this point?  I feel that with this itching, her liver is shutting down even more and I don't feel that either my sister or her GE is taking this very seriously.  I just cannot understand with the serious diagnosis 5 yrs. ago, why she has never been referred to a liver specialist.  She is in Florida - Broward Co.  My sister says her doctor is in a state of the art facility there and she feels she gets excellent care.  

I don't have much say in regards to my sister as she has never come clean with her diagnosis, but I know enough that she is turning a new corner in this condition and she should start taking things more seriously.  I feel that if her GE referred her to a liver specialist, that my sister would see one.  But that doesn't seem to be happening.  

[HectorSF]

When liver disease is assessed by liver biopsy the result can be as a METAVIR score. The METAVIR score helps interpret a liver biopsy. When the biopsy is performed, doctors need a reliable way to quantify what is seen under the microscope. This scoring system assigns two standardized numbers: one to represent "the degree of inflammation" and the other "the degree of fibrosis".

What Does My METAVIR Score Mean?

The fibrosis is graded on a 5-point scale from 0 to 4.
The fibrosis score indicates "the stage" of liver disease. Cirrhosis being stage 4 liver disease is the last and final stage of liver disease.

Fibrosis score:
F0 = no fibrosis
F1 = portal fibrosis without septa
F2 = portal fibrosis with few septa
F3 = numerous septa without cirrhosis
F4 = cirrhosis

The activity, which is the amount of inflammation (specifically, the intensity of necro-inflammatory lesions), is graded on a 4-point scale from A0 to A3. The activity score indicates how much inflammation there is and is an indication of how quickly the liver disease is progressing.

Activity score:
A0 = no activity
A1 = mild activity
A2 = moderate activity
A3 = severe activity

There are also other ways to diagnosis cirrhosis which don't involve an assessment of "the degree of inflammation".

All people with stage 4 liver disease (cirrhosis) regardless of the amount of inflammation need to be under the care of a liver specialist. The underlying cause of their liver disease, if at all possible, needs to be addressed before their cirrhosis progresses to the point where it is irreversible at which point  only a liver transplant can save the patient's life.

For some causes of liver disease for example such as hepatitis C the virus can be eliminated and the person's liver disease in most cases can be stopped and reversed over time. For other it can at least be slowed down with proper treatment. In others there may be no available treatment and they should be listed for a liver transplant and monitored periodically as there liver disease progresses.

Hector