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My fibrosis score is a 4 how do you find out what your cirrhosis score is

I am in month 2 of hep c treatment and my liver pain had eased but is now back and feels like im feeling on my left side also
4 Responses
683231 tn?1467323017
Your liver is on your right side. The liver has no pain receptor nerve endings.

I am assuming you mean a Fibroscan score. Were you given a test with a machine? If not what methodwas used to determine what you refer to as a fibrosis score of 4?

If you google Fibroscan score card images you will see the scale for the Fibroscan goes from 0 to a max of 75

The lowest possible result for fibrosis caused by hep c is in the 0 to 6 range which is a score of F1 the lowest score possible.

For reference my Fibroscan score is 33 which is F4 cirrhosis that starts at a score of  about 15 for hep c.

My liver cirrhosis was diagnosed by liver biopsy in 2008.

The fibrosis score from a liver biopsy is as follows:

F0 = no fibrosis
F1 = portal fibrosis without septa
F2 = portal fibrosis with few septa
F3 = numerous septa without cirrhosis
F4 = Cirrhosis

So I need to know which test you took that provided you the score.

Did you have a liver biopsy where they the insert a needle into your liver a take a sample? Did you have a Fibroscan using a machine? Or did you have a blood test called a fibrosure

Of course you really should be asking your doctor this question
3 Comments
I had a fibroscan and i was told it showed me to be a f4
A fibrosis score of F4 is by definition cirrhosis as I posted above.

Didn't you doctor discuss your results and meaning of your result with you?
You really shouldn’t be learning t this from a stranger on the internet.

Once you are diagnosed with cirrhosis there is not really a score. Either you are compensated where your liver is not so badly damaged where it can still do it’s important functions or it can become so badly damaged and you will begin to develop symptoms of decompensated cirrhosis like Edema, Ascities, esophageal varicies or Hepatic Encephalopathy.

I have some mild edema and a small amount of ascities only visible on ultrasound. I also have had grade 3 esophageal varicies that requires banding to prevent a dangerous bleeding event.

Do you know your MELD score (Model for End-Stage Liver Disease)

You can google a MELD score calculator and using just a few of your lab tests find your score.

The MELD score is used to stage patients for liver transplant. The scale is 6 to 40. You need a MELD score of at least 15 to  be placed on the liver transplant list assuming you’re eligible.  Most patients who receive transplant have a MELD score of above 30.

My MELD score is 7.

I assume you are having  abdominal ultrasound performed every six months along with the test for alpha-fetoprotein (AFP) which is a liver cancer marker. I also hope you have had an upper endoscopy to check for Esophageal varices. You should also  be immunized against hepatitis A and hepatitis B.

Are you seeing a hepatologist associated with a liver transplant center?
All i was told is it is compensated still. Literally no more conversation about follow up on it or anything just being told after my mavert is gone ill be fine
683231 tn?1467323017
I did find this on stages of cirrhosis

Stage 1 Cirrhosis

Stage 1 is the earliest stage of cirrhosis and is characterized by the absence of two significant complications known as varices and ascites. Varices are dilated, ballooned veins. They are most often located in the lining of the esophagus and/or stomach. Acsites refers to an accumulation of fluid in the abdominal cavity. Both varices and ascites develop primarily because of obstructed blood flow through the liver, a condition known as portal hypertension. While people with stage 1 cirrhosis have extensive liver scarring, it is not severe enough to cause substantial portal hypertension and its complications.

Stage 1 cirrhosis is considered compensated cirrhosis. This means that despite extensive damage, the liver is not yet so severely scarred that clinically apparent signs of liver failure have developed. People with stage 1 cirrhosis generally do not experience many symptoms other than perhaps lack of energy and fatigue. Stage 1 cirrhosis is potentially reversible if the underlying cause of the cirrhosis is eliminated or cured.

Stage 2 Cirrhosis

Stage 2 cirrhosis is marked by the development of esophageal varices, due to worsening portal hypertension, but without the presence of ascites. While the development of esophageal varices indicates worsening cirrhosis and an increased risk of dying in the next 12 months, stage 2 cirrhosis is still considered compensated cirrhosis. There remains the potential for at least partial reversal of liver damage if the underlying cause of cirrhosis is eliminated or cured.

Stage 3 Cirrhosis

Stage 3 cirrhosis is marked by the development of ascites, with or without the presence of varices. The volume of ascites varies from being detectable only with imaging tests, such as abdominal ultrasound, to obvious bloating of the abdomen. The development of ascites signals worsening portal hypertension due to advancing liver scarring and deterioration of liver function. Stage 3 cirrhosis signals decompensated cirrhosis, meaning the liver is failing. Once decompensated cirrhosis develops, liver scarring is irreversible and evaluation for liver transplantation is generally recommended. A variety of signs and symptoms may be present with stage 3 cirrhosis, including:

pale and/or yellowish skin
weight loss and loss of appetite
shortness of breath
extreme fatigue
persistent, widespread itchiness
swelling of the feet, ankles and lower legs
wasting of the muscles of the arms and legs

Stage 4 Cirrhosis

The defining feature of stage 4 is gastrointestinal bleeding, usually from ruptured varices in the esophagus or stomach. This type of bleeding can be immediately life threatening if not controlled. Even if bleeding stops or is medically controlled, however, individuals with stage 4 cirrhosis still face a high risk of dying within 12 months. Persons with stage 4 cirrhosis have end-stage liver disease and urgent evaluation for possible liver transplantation is necessary. Signs and symptoms that might develop include those that may occur with stage 3 cirrhosis as well as others, such as:
confusion, personality changes and/or extreme sleepiness
hand tremors
reduced urination, which may indicate kidney failure
high fever, signalling infection of the abdominal cavity
2 Comments
But i do feel like a have a few of the milder symptoms of decompensated as the weight loss loss of appetite itchiness and fatigue badley. I did just have an appt with my family dr to try and get some answers but she pretty much said trust the drs
Fatigue is common both with hep c and cirrhosis. Itchiness associated with cirrhosis is a late stage development and caused by elevated Bilirubin. If you had a high enough Bilirubin to cause itching from cirrhosis you would also be jaundiced developing yellow eyes and skin. This is a late stage of cirrhosis.

Weight loss in cirrhosis really is muscle wasting when basically the body begins consuming itself . This kind of weight loss is associated with very decompensated cirrhosis in the end stages of the disease.

“Muscle wasting is defined as the progressive and generalized loss of muscle mass. Muscle depletion is a common feature of chronic liver disease found in approximately 40% of patients with cirrhosis. Its etiology is multifactorial subsequent to liver failure and its prevalence increases along with disease severity.”

The most common early symptom of cirrhosis is swelling of the feet and lower legs called pitting edema. Edema is swelling in the body caused by excess fluid. It often affects the lower body, such as the legs, feet, and ankles, but it can occur anywhere. If you press on a swollen area and an indentation or pit remains, it’s called pitting edema. If there’s enough fluid, and the swelling is from fluid and not something else, then most edema will pit.

I developed pitting edema about 6 months after my cirrhosis diagnosis. The next sympton I developed was a low platelet count. Min normal is 150 my platelet count before my hep c was cured was about 80 to 90. And then the esophageal varicies which have no symptoms and are only found by having an upper endoscopy.

But really the only symptom I have that I would know about is the edema the rest are from tests. Even though I have had cirrhosis for 10 years and 7 months I feel fine but I know I’m really not.

Being cured of hep c some people have had improvement in their cirrhosis. I have read about 50-50 chance of some improvement but this is of course how long you have had cirrhosis and how much damage has your liver endured.

So far 3 years cured my liver really hasn’t improved at all so I just hope it doesn’t get any worse and that I don’t develop HCC. But I figure every year that goes by my odds of not getting HCC are better and better.
683231 tn?1467323017
For post treatment follow up the AASLD recommends that those with less than F2 fibrosis wontbrequire any special follow up after cure.

But for those patients with F3 fibrosis or F4 cirrhosis they recommend abdominal ultrasounds and AFP (alpha fetoprotine a tumor marker) blood testing every 6 months to monitor for early signs of heptocellular carcinoma (HCC) aka liver cancer because those of us with cirrhosis are at increased of developing liver cancer. Although with cure that risk is greatly reduced.

Although with cure we are much less likely to develop greater amount of liver disease and decompensation there is still some risk especially if you have any fatty liver issues.

I assume you have stopped drinking.

From the AASLD

“Surveillance for hepatocellular carcinoma with twice-yearly ultrasound examination is recommended for patients with advanced fibrosis (ie, Metavir stage F3 or F4) who achieve SVR.

A baseline endoscopy is recommended to screen for varices if cirrhosisa is present. Patients in whom varices are found should be treated and followed as indicated.“

I had grade 3 esophageal varicies back in 2012 so I was having annual upper endoscopies until last year and now my hepatologist said we can go to every two years. I have an abdominal ultrasound and AFP test every six months.

When I was diagnosed with cirrhosis in Jan 2008 my doctor had me get vaccinated for hepatitis A and Hepatitis B. I have been advised to get my flu shot as soon as it becomes available every year because those of us with cirrhosis and advanced liver disease are considered medically fragile like those with other chronic diseases.
3 Comments
My dr just discussed with me having an edg i believe it is and biopsy every 6 months and a liver ultrasound every 6 months. I go for my first scope and biopsy at the end of this month. She also told my i have a meld score? And it is to low to have me put on the transplant list so id say thats a plus. Thank you all for your help
An EGD is an upper endoscopy. Unless they are treating enlarged or bleeding esophageal varicies 6 months is excessive and if they are treating varicies you would be having upper endoscopies much more often to treat the varicies until they were gone.

Like I said I had an initial upper EGD and had grade 1 varicies (small) and we did not check again for 2 years.

This doesn’t sound right I would ask them about this or get a second opinion.
The MELD score is based on some of your blood test results. Really you could use a healthy persons test results and give them a MELD score which would come out on the bottom of the scale at 6. The scale goes from 6 to 40.

You need a MELD score of 15 to get on the list and most patients have a score around 30 when the receive a transplant. The MELD score is used to rank patients by severity of illness for transplant priority.

My MELD score is 7.

You can google MELD score calculator and using you test results track your MELD score. Hopefully you have online access to your test results through your doctors office or st least are getting copies of your labs for your records.

MELD stands for Model for End-Stage Liver Disease. End stage just means cirrhosis as there is no higher level of liver damage.
475555 tn?1469304339
A biopsy every six months is excessive. I never heard of anyone having such frequent biopsies. I would seriously question this if I were you. Liver biopsies are not without risks, and furthermore are notoriously unreliable for various reasons: the specimen comes from the periphery of the liver (HCV-related fibrosis is not homogeneous throughout the liver), the size of the specimens can vary widely, there is great discrepancy in observation (operator-dependency), etc.  Biopsies are usually done when HCV is diagnosed, and then prior to a trial. They are not required or recommended before or after Tx. If someone is scheduling you for bi-annual biopsies they have to have a very special reason for doing so. I believe that a second opinion, from a hepatologist specializing in HCV, would reject them.
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