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cirrhosis vs. esld

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Posted 5/31/2011 9:59 PM (GMT 0)
I need some educating...

What are the differences between ESLD and cirrhosis?

Thanks.
Posted 5/31/2011 10:44 PM (GMT 0)
They are basically the same, although cirrhosis is graded. Mild cirrhosis wouldn't necessarily mean end stage. But a Grade 3, Stage 3-4 cirrhosis like I currently have (along with the HCC) makes me end-stage. I went for many years after hep C diagnosis with no cirrhosis noted...but in '07s biopsy, there was cirrhosis.

Maybe someone else has a clearer explanation.

Hugs,
Connie
Posted 5/31/2011 10:50 PM (GMT 0)
Thank you Connie.

How many grades are there? I think I have read 4?

The grades are determined based on biopsy? Or other symptoms?
Posted 6/1/2011 12:35 AM (GMT 0)

Four grades and four stages.  Based on the amount of scarring.

Hugs,

Connie

Posted 6/1/2011 6:19 AM (GMT 0)
ESLD is when your liver goes from compensated to decompensated.

The Child-Hugh Score is also commonly used to score cirrhosis. It is scored A, B and C. Here is a link to a online calculator for the Child-Hugh score.

http://www.mdcalc.com/child-pugh-score-for-cirrhosis-mortality

Liver scarring is graded in four grades and stages. Fibrosis 1, 2 and 3 and cirrhosis is 4. The grades are inflamation and they are graded 1,2,3 and 4.

For example I am stage 1, grade 1.  You can also sit in the middle of two stages for example stage 1-2 or 3-4. 

Posted 6/1/2011 2:34 PM (GMT 0)
I have an appointment with my doc tomorrow. Thanks for bringing this topic up! I have ESLD and a biopsy in 2009 diagnosed cirrhosis. I think I may have asked him what stage of cirrhosis my liver cirrhosis was in, but my doc is a fellow and he seems to answer questions in a roundabout way. It is like he does not want to state anything in concrete in case he is wrong. I am on my third doc and he was the only one who got my fluid of ascities and edema under control. The other 2 docs were like just deal with it. You are not going to explode, until I went to an emergency room and tyhey promptly scheduled a paracentesis. Some docs do not believe in them or think there to dangerous but I was having a lot of problems with fluid, severe cramps and pain. I will ask my doc what stage of cirrhosis tomorrow. BostonMike.
Posted 6/1/2011 2:42 PM (GMT 0)
Mike-I hope that your appt tomorrow goes well. Please post back and let us know how everything goes.

Emma
Posted 6/1/2011 4:19 PM (GMT 0)
Im most confused by both MELD and Childs.

Neither takes into account viral infection (or do they?)

They both imply cirrhosis = death - be it now or in 15 years time - irrespective of infection or not.

So - does Cirrhosis = Death?
Posted 6/1/2011 4:47 PM (GMT 0)
Mr. E,

Make an appointment with a physician - he can answer your questions. 

Pam

Posted 6/1/2011 8:42 PM (GMT 0)
Boston Mike, We are having a hard time with water, and cramping also. My husbands doctors change the diuretics often. He went in for parenticisis, and the water is not in pockets, its in the tissue next to the skin, so they could not do it. He looks like he's 9 months pregnant and going to explode . . we are waiting to hear back from the doctors on what they are going to do. He has never had a biopsy done, chirosis was confirmed from CAT scan. it's very frustrating to see him like this and not hearing anything from the doctor on what to do about it.

I hope all goes well at the doctor tomorrow. Best of luck to you!!

Debbie
Posted 6/1/2011 9:33 PM (GMT 0)
Hi Mike,
I'm sure your doc will tell you the degree of cirrhosis, as it's fairly well defined, just as your tests are. They do tend to be round about with some things, because (as with all aspects of liver disease) it's a roller coaster ride and there's no certainty of what will come next. It would be good to find out where you're at. Be well.
Posted 6/1/2011 9:45 PM (GMT 0)

Hepmom, thanks for your input.  However, since a biopsy in '07 showed cirrhosis, why would he say Grade 3?  I never paid much attention to this anyway...how I'm feeling and my lab values mean a lot more personally than stages and grades.

Hugs,

Connie

Posted 6/2/2011 5:37 AM (GMT 0)
Grade three is the inflamation in your liver. Three is high which means the Hep c is causing damage and inflamation. Stage 3-4 is bridging fibrosis and the start of cirrhosis. At the time of the biopsy your liver was probably on it's way to being cirrhotic but was not fully at stage 4 which is why you were staged at 3-4. So when your liver is at 3-4 unless you do something to stop the damage your liver will become fully cirrhotic.
Posted 6/2/2011 6:19 PM (GMT 0)

Thanks for the info, HepMom.  As I said, I don't really worry about this or about viral loads.  I trust the Mayo docs to do what needs to be done.  I have enough other things (like liver cancer) to concern me.

Hugs,

Connie

Posted 6/2/2011 8:27 PM (GMT 0)
I don't worry about viral loads either! I will keep any eye on the stage of my liver though. I want to treat my hep c before I end up with advanced liver disease. I agree your main concern is the cancer at the moment.
Posted 6/3/2011 12:18 AM (GMT 0)
I noticed your siggy says Hep C since '88. Is that when you know you contracted it? When were you diagnosed? I know that prior to '93, they were calling it non-A, non-B...at least that's what my doctor said when I tested positive for it. She said had it been the prior year, there was no test for hep C. Actually, I had symptoms of unusual fatigue for 2 yrs. prior to diagnosis, but my then doc kept blowing me off and saying it was hormones, it was smoking, etc.

Hugs,
Connie
Posted 6/3/2011 12:30 AM (GMT 0)
I contracted Hep C in 1988 when I was young and dabbled in drugs.  I spent the next 20+ years drinking heavily.  I stopped drinking before I was diagnosed in Jan 2010.  I asked to be tested after doing research on symptoms I had for another unrelated condition.
Posted 6/3/2011 12:51 AM (GMT 0)
On this note, I do have a question. When hubby was diagnosed 7 years ago, they did his liver biopsy and said he was stage 4 cirrhosis. Obviously, they have kept a watchful eye on him with ultrasounds every 3 months, blood work, etc....but, my question is this. Once they do a biopsy, is it ever necessary to do another one??? I have family members asking me why they have not done a follow up, and I have asked the docs if they will ever do another one since it's been so long, and they tell me no. Is it that once they know it's cirrhosis, what's done is done??

Mer
Posted 6/3/2011 2:00 AM (GMT 0)

Mer, yes...it's told them all they need to know.  Does he get abdominal CT scans or MRIs (both with contrast) every 6 mos.?  If not, he should...or an ultrasound at the very least...to check for liver cancer.  Having hep C puts one at high risk for HCC (hepatocellular carcinoma.)

HepMom, your story sounds like mine except that I had stopped drinking 7 yrs. prior to diagnosis.  Just didn't like the person I was becoming and my life was pretty much unmanageable.

Hugs,

Connie

Posted 6/3/2011 3:23 AM (GMT 0)
Connie,

Thanks. That's what I suspected but wanted to make sure. He has not had a CT or MRI w/ or w/out contrast in a very long time, but he does get a doppler ultrasound every 3 months to make sure he's not developing HCC. However, I did notice in the most recent paperwork from the transplant center that they are now requiring that we alternate the ultrasound and an MRI....so, since he has not had an MRI in a VERY long time, I think as soon as we get the financial approval back( They are working on that now), I may push for that since he will have to have blood work and a colonoscopy/endoscopy done as well. Might as well get it all done, huh??

Mer
Posted 6/3/2011 5:31 AM (GMT 0)

Did you end up having to divorce your husband, Mer?  What made them reconsider coverage for him?  I've heard from friends and acquaintances recently about them having to divorce hubbies so they can get Medicaid on their own.

I think it's great that they are now requiring an MRI to alternate with ultrasound.  They generally use Gadolinium for contrast when doing the abdominal MRI.  It will light up wherever there is cancer.  I was diagnosed with HCC via ultrasound, but I honestly think it was missed the previous year, given its size of 12 cm x 11.5 cm.  Unless the radiologist really knows what to look for, it could slip by if very small.

Please keep us updated on his results when he has them.

Hugs,

Connie

Posted 6/3/2011 5:59 AM (GMT 0)
Will do, Connie!

I have not filed for divorce. My unemployment benefits ended, and that's how we have been able to get his SSI/Medicaid benefits started back up. I have a friend that has a catering business and she's going to put me to work catering parties for her, and pay me under the table basically. So, if I can do that and just do odd jobs here and there to make up for the loss of UE, then we will maintain. Otherwise, will have to file for divorce so I can get a job and him not lose his benefits. It's really sad that you have to make those choices, but at this point, this is what it will take to save his life.

I will keep you posted on his results. I need to follow up with the financial adviser on the transplant team tomorrow and see where they are with verifying his medicaid again so I can call the coordinator and get everything scheduled. June has barely started and I can see it's going to be a very busy month!

Thanks for all your updates, Connie!!

Mer
Posted 6/3/2011 5:27 PM (GMT 0)
cool  David, I asked my liver doc the question again about what stage of cirrhosis. His answer was that I have cirrhosis and it is in the decompensated stage or ESLD from my liver biopsy. I already knew that. The 2nd part of the question: What stage of Cirrhosis? He put it in terms of Stages A, B, C instead of 1-4 and I am in the A stage. Oh, and I now have Dr. Pratt as my Team leader hepatologist. He also confirmed this with my Attending Hepatologist Dr. Mullen that My Meld score is around an 8 or possible 9 because of slight fluid retention or ascities and edema. I know you said he was your doc pre-transplant. It was the 1st time I met him. They also agreed that I was doing well considering having a grasp on controlling the fluid myself and commending me for sticking to the very low sodium diet. Dr. Pratt has a way about him that everything is going to be o.k. with me. I felt a sense of relief when I left the exam room.

Cable Poodle, I know what your husbands going through. I was taking Furosemide and Spironolactone and it just was not getting rid of the fluid and had terrible time with cramping, dehydration, fatigue, muscle wasting ballooned stomach from Ascities and swollen legs ankles, feet and numbness in the feet and toes. I still have slight numbness

in my toes, especially my right toe. After months of agony and 3 Paracentisis within 3 months I changed my liver doc and hospital MGH in Boston,MA. The new hepatologist gave me a diuretic called Metolazone, a 5mg. strong little pill. At first he said to take 2 a day, 10 mg. and I was dropping the weight fast, like 3-5 pounds a day. I ended up in the ER with dehydration and low sodium blood level. My doc dropped the dose to 2.5 every 3 days instead of 10 mg each day. I only lasted 2 days on the latter dose. Very strong little pill which I had to cut in half. I continued the 2.5 every 3rd or 4th day for 2.5 or 3 weeks and went from 245 down to 195. You could run it by your doc. I am not sure if you will qualify or whatever but I also was able to get a paracentisis and you were not. Also, Metolazone is hard on th body and the kidneys, too. So, you want to take it as seldom as possible. Side effects include ringing ears, fatigue, and dehydration because you lose the fluid so fast. That was over a year ago. Today i am 185 pounds and still use Metolazone periodically when I retain fluid. My doc wants me to stay under 190. It is part of my regiment of meds. BostonMike.

 

Posted 6/3/2011 9:32 PM (GMT 0)
Hi Mike,
I quit posting in here a couple of days ago. As I was unable to find your email address, get in touch. Mine is on here. Dr. Pratt is a great guy/doctor.
Posted 6/5/2011 10:24 PM (GMT 0)
Thanks Boston Mike for the advise. He is taking it twice a day . . his doctor took him off some of his other diuretics, due to cramping and itching. This water has been unreal. He looks like he's 9 mos pregnant right now!! He's miserable and has pain. His doctors were out of town all last week. I'm going to be calling them in the AM. I think the difference is his fluid is in the skin tissue . .I wish I knew!!

I got layed off a week ago, so now I can go to the doctor with him again. I get alot more answers than he does!!

Thanks for your input

Debbie
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