nash fibro and cirrhosis

[Bm2016]

while I've been indulge myself with uncontrolled eating habit and lifestyle, one day after eating a medium rare cooked very grease food, i have a upset stomachache, diarrhea, vomit and sharp lower back pain, i decided to take visit to family doc, and performed the urinalysis, blood work and complete ultrasound on abdominal, got the worse news than having heb b, ultrasound revealed, has progressed to the next liver damaging stage.

i am in early 40s, was hep b carrier, possibly since birth, just got functional cured on hep b 2 years ago, now still hbsab reactive, hbsag non-reactive.

the most recent ultrasound report seems contradict with NASH fibrosure,  
which one is more accurate?


comparison to last ultrasound(was normal) from 3 years ago,
EXAM DATE AND TIME: 8/3/2017 7:24 AM EDT
INDICATION: RUQ pain;    
COMPARISON: Prior ultrasound from 11/5/2014.
TECHNIQUE: Abdominal ultrasound

IMPRESSION:
Hepatic steatosis with likely early cirrhosis.

FINDINGS:

LIVER: Increased echogenicity. The surface appears nodular
BILE DUCTS: No intrahepatic or extrahepatic biliary ductal dilatation. Common duct measures 5 mm.
GALLBLADDER: Within normal limits.
PANCREAS: Portions of the head , body, and tail are grossly within normal limits.
SPLEEN: within normal limits.
RIGHT KIDNEY: Survey views show no hydronephrosis.
LEFT KIDNEY: Survey views show no hydronephrosis.
UQ ASCITES: None.
UPPER IVC and AORTA: grossly within normal limits.


and the dr. called me back immediately and performed NASH fibrosure, WBC and differential, prothrombin time and INR, lipid panel,

here are the NASH Fibrosure detail

Component Your Value Standard Range
Fibrosis Score 0.11   0.00 - 0.21
Fibrosis Stage Comment  
F0 - No fibrosis
Steatosis Score 0.37   0.00 - 0.30
Steatosis Grade Comment  
S0 - S1 No Steatosis - Minimal Steatosis
NASH Score 0.25   0.25
NASH Grade Comment  
N0 - Not NASH
Height: 67 Inches Inches
Weight: 151 LBS LBS
Alpha 2-Macroglobulins, Qn 137 mg/dL 110 - 276 mg/dL
Haptoglobin 96 mg/dL 34 - 200 mg/dL
Apolipoprotein A-1 132 mg/dL 101 - 178 mg/dL
Bilirubin, Total 0.3 mg/dL 0.0 - 1.2 mg/dL
GGT 46 IU/L 0 - 65 IU/L
ALT (SGPT) P5P 38 IU/L 0 - 55 IU/L
AST (SGOT) P5P 22 IU/L 0 - 40 IU/L
Cholesterol, Total 180 mg/dL 100 - 199 mg/dL
Glucose, Serum 90 mg/dL 65 - 99 mg/dL
Triglycerides 79 mg/dL 0 - 149 mg/dL

Complete Blood Count and Differential detail
Component Your Value Standard Range
WBC 9.2 x10E3/uL 3.4 - 10.8 x10E3/uL
RBC 5.01 x10E6/uL 4.14 - 5.80 x10E6/uL
Hemoglobin 15.1 g/dL 12.6 - 17.7 g/dL
Hematocrit 44.8 % 37.5 - 51.0 %
MCV 89 fL 79 - 97 fL
MCH 30.1 pg 26.6 - 33.0 pg
MCHC 33.7 g/dL 31.5 - 35.7 g/dL
RDW 12.6 % 12.3 - 15.4 %
Platelets 237 x10E3/uL 150 - 379 x10E3/uL
Neutrophils 70 % %
Lymphs 23 % %
Monocytes 5 % %
Eos 2 % %
Basos 0 % %
Neutrophils (Absolute) 6.3 x10E3/uL 1.4 - 7.0 x10E3/uL
Lymphs (Absolute) 2.1 x10E3/uL 0.7 - 3.1 x10E3/uL
Monocytes(Absolute) 0.5 x10E3/uL 0.1 - 0.9 x10E3/uL
Eos (Absolute) 0.2 x10E3/uL 0.0 - 0.4 x10E3/uL
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 x10E3/uL
Immature Granulocytes 0 % %
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 x10E3/uL


Component Your Value Standard Range
INR 1.0   0.8 - 1.2
Prothrombin Time 10.2 sec 9.1 - 12.0 sec

Component Your Value Standard Range
Hep B Surface Ab, Qual Reactive  
HBsAg Screen Negative   Negative

[Bm2016]

I took viread for almost a decade and visit GI dr every 6 month with bloodwork, my hbv DNA was undetectable for about 3 years, and the one day from blood work flared up to 1800 Ui/ml, then went undetectable again in 2 months, and 6 months later the hep b surf antibody reactive.   the GI dr sent me home after I have the hep surface anti-body reactive and hep b surface antigen non-reactive, hbv DNA undetectable after 1 year.  Now I no longer need to visit GI dr for hep b, no need to take any drug, don't feel tire, no headache, no cold, no cough, running nose, no fever, life is great, infact just came back from a Cancun vacation, everyone else has a fever and sore throat, must be too much Mexican water corona, but I am fine.

[melcul]

i thought that once you got rid of the virus the liver would manage to repair itself now that is not harmed anymore, also, don't you need fibroscan or a biopsy now that they discovered some nodules on your liver ? how did you get rid of the virus btw, what treatment did you followed ?

[Bm2016]

I was told by dr. that I can never get rid of this hep b virus, at least with today technology, I will carry this virus for the rest of my life.  This cccDNA enables this virus replication forever,  what I got is my own immune system has developed hep b surface antibody that can suppresses the remanent of the hep b virus lives deep in liver cell. Therefore, no hep b virus floating in my body.
Every year about 1% to 2% of hep b patient population gone through this functional cured of hep b surface antibody seroconversion, with or without medication,  I was one of the lucky one.

Even though ultrasound revealed steatosis and early stage cirrhosis, further test test from NASH fibrosure from labcorp, complete blood count and lipid panel from blood work, as well as physically I feel strong and healthy, the GI dr. Said I am fine, but need to loose weight to get rid of extra fat in body, watch for glucose and cholesterol as my age goes up.

I did liver biopsy 2 times before when I was still having hep b and high alt at triple digit range, At the time biopsy was normal, no fatty liver
But I read since liver is the largest organ, the invasive biopsy only sampled 1/5000 of the area.
May not represent the entire organ.

How accurate is ultrasound
And how accurate is bloodwork NASH fibrosure?
Would fatty liver and cirrhosis shown up on bloodwork?