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Posted 5/25/2010 8:16 PM (GMT 0)
Hi Everyone,

I was dx about 12 years ago with UC, now due to consistently (slowly) elevating LFTs my dr ordered a Liver Biopsy, It is scheduled for next tuesday. Anyone else have this procedure done. I always cringe on "House" when someone gets stabbed with a big needle now that person is me. Should I be as nervous as I am?
Posted 5/26/2010 12:16 AM (GMT 0)
     Never had a liver biopsy but have to comment on "HOUSE".  That is my favorite show but a little off the wall.  Can you imagine having a doctor like House taking care of you in the hospital?  OMG!
Posted 5/26/2010 12:26 AM (GMT 0)
Hopefully, Quincy will come along and offer some advice.

My liver panel has bounced up and down over the years, and I've consulted a liver specialist from time to time.  I opted not to take anything further than blood tests and "watchful waiting" but there are easier (on you) tests that can be performed before a biopsy, MRCP being one of them.

From my vantage point, I didn't think a biopsy would provide information that would lead to a definite diagnosis or better treatment options. 

Posted 5/26/2010 3:39 AM (GMT 0)
Hi...personally, I'd never have a liver biopsy unless I was on my deathbed. You should suggest that you wait and request an MRCP (liver/abdomen MRI) before anything invasive.

It was suspect that I had it in 1998 because of my liver elevations as well....the liver specialist wanted to do an ERCP. I read stacks of info and was quite distraught at the fact that I had a fatal disease. One paper in that info stated that better testing should be available because of the risks of the invasion tests, one being the PSC to be triggered into an active state if it was indeed in the early stages..the other being pancreatitis.

I wanted neither and opted for no invasive tests unless I turned yellow and needed a liver transplant.

There is NO cure for PSC....and according to the MRCP, I have it in early stages. Autoimmune marker tests state I have PBC (primary biliary cirrhosis)...so, do I have one or the other or both?
I'm on URSO....liver enzymes have gone back to normal.

I'm due for another MRCP in the summer.

Please....before you have any invasive testing, opt for the MRCP initially and a host of other marker tests, etc..

My take on it.
quincy
Posted 5/26/2010 11:43 AM (GMT 0)
I had an MRCP last year and the results came back negative (everything looked good - except my colon of course). My LFTs have slowly been creeping up over the last few years. My GGT is over 500, other levels just over 100 :(. My Dr. said it is not high but high enough that we need to take a closer look. I am so nervous about the Biopsy, I am finally getting better with needles and now a big needle through my chest OUCH. On top of that, I just discovered I also have Mitral Value Prolapse, echo scheduled for tomorrow just to make sure thats it. I am so nervous with all of this. My wife is 17 weeks pregnant with our first child and I want to see them grown up.
Posted 5/26/2010 5:10 PM (GMT 0)
I'd opt for another MRCP before the biopsy I think.

The other thing is get referred to a rheumatologist and see if he/she can find another path to a possible problem.

I don't know if some heart defects can cause increase in some enzymes.

You should do the research.

Oh, I heard pregnancy can increase them....too bad you couldm't use your wife's pregnancy as a reason..lol.

I still think there's another path....just to be sure....other blood tests possibly.

quincy
Posted 5/26/2010 6:01 PM (GMT 0)
I was thinking about seeing a rheumatologist. I have had upper back pain (by both shoulder blades) for over a year. It comes in goes, some days it is worse then others. Both my Gastro and General Physician don't have anything to say. Chiropractor doesnt see anything either.
Posted 5/27/2010 5:35 AM (GMT 0)
Definitely get checked for ankylosing spondylitis...connection with UC is probable, as well as the PSC. Hey...why not add something ELSE to the mix.

Yes, a rheumatologist is a good idea.

Keep us posted if you have the liver biopsy. I know there have been some members who each have had a few liver biopsies....with NO diagnosis. WTH???

I still opt for the MRCP. Unless you're in complete distress and blood tests don't lead to another contrary such as cancer markers, etc....then "maybe" consider the biopsy. To me, any intrusive testing can lead to other issues, especially if the body is already in a reactive state.

Besides...they can't do anything for the PSC except give you URSO....and if the biopsy is done in an area that's not affected by PSC...then what?

Again...all my perspective with strong opinion.


If you haven't checked it out yet....lots of info.



http://www.pscpartners.org/



If you go for the biopsy, maybe have a list of questions to ask the doctor.



quincy
Posted 5/27/2010 10:38 AM (GMT 0)
From what I've read, a biopsy won't necessarily help diagnose PSC.  It's useful for staging late-stage disease, but if you haven't been diagnosed, it may not show anything. 

Liver biopsy has its purposes, but better imaging techniques have largely replaced it.

Good luck.

Posted 6/4/2010 3:06 PM (GMT 0)
Ok, I had the biopsy on wednesday. While it was no were as bad I was expecting still not something I want to do again. I will be going over the results with my gastro early next week.
Posted 6/4/2010 7:45 PM (GMT 0)
Good all went well with no problems.....looking forward to your results.

Thanks for checking in with us.

Don't forget to ask about rectal meds!

q
Posted 6/15/2010 2:17 PM (GMT 0)
Well,

I finally talked to my Gastro last night.

My liver biopsy results came back:

Mild Scaring
Mild - Moderate Inflammation
Consist with HepC (Which I do not have)
Indeterminate for PSC

Last blood test showed:
GGT over 500
All other LFTs just over 100

However, he requested the pathologist check it again with my history in mind.
He may also send the sample to PA, for a more detailed analysis.

He said, "With me only 29 yrs old, and the possibility of a progressive liver disease he wants to keep an eye on it."
I am really scared my wife is 19 weeks pregnant with our first child, I want to see them grow up.
Posted 6/15/2010 5:50 PM (GMT 0)
And you already had an MRCP??

I'm scared for you as well...what are all the blood tests you've had to help regarding possible autoimmune hepatitis, PSC, etc? Do you have copies of them all?

Did he mention or suggest you should be on ursodiol?


You should also be on rectal meds....my opinion is to keep all inflammation down as best and as long as possible.

Have you checked out the www.pscpartners.org yet?

This article you must read....print it and start with the research regarding blood tests, etc. create a list of questions and maybe requests for blood testing.

http://www.pscpartners.org/PSCDiagnosis.pdf



q
Posted 6/15/2010 6:31 PM (GMT 0)
I had an MRCP about a year ago, and everything looked normal.

He did mention putting me on ursodiol, but he wants some more info before he does that.

How high were your LFTs before ursodiol?

I have Rowasa, maybe I should start using them again.
However, they will do nothing for my liver.
Posted 6/15/2010 6:42 PM (GMT 0)
The enemas won't do anything directly for the liver, but MY belief is keeping the UC inflammation down can also have an effect on the liver autoimmune reaction (if that's indeed what you have).

Please don't keep getting liver biopsies.....just my opinion, however.

I'll have to go through my results...I don't have them from 1998 when I saw the liver doc initially when it was suspect I had PSC. I refused the ERCP at that time, and in 2006 I had the MRCP when it became available.

When I was put on URSO, my liver enzymes went down to normal soon afterward.

One thing that has stayed up are my cholesterol levels.....are yours normal or high?

I'll post my results this evening when I've had time to go through them...I'll post the tests and an average of the results since they did fluctuate.

Hang tough...don't react in a panic by having tons of testing done unless you have a plan. With the testing, nothing can be done anyway....and to encourage other possible problems with invasive testing is what I'm wanting you to avoid.

Have you had ultrasounds?

q
Posted 6/15/2010 7:35 PM (GMT 0)
I had an ultrasound of my lower abdomen a couple years ago, except for my colon everything looked fine.
My cholesterol has been around 195 - 200 since my first blood test when I was 17.

I don't want to have an ERCP, it is a lot more invasive then the Liver Biopsy.
My doctor said we are not at that point yet.
Posted 6/16/2010 5:59 AM (GMT 0)
Well, you should push for going on the URSO possibly....it won't hurt I don't think...

Please check out all the blood tests you need to have done and enquire/request that the doctor help with that.

You've been checked for hep C? but autoimmune Hep? Don't know if that would cause the scarring.

q
Posted 6/23/2010 2:15 PM (GMT 0)
I talked to my Doctor again.

He was able to get an amendment to my Biopsy, the report showed that the sample is consist with PSC.
He called in a script for Urso which I am to start taking immediately.

I meet with him again the end of July.
I was doing some more research and 3% of people during Lialda trials, experienced high LFTs, and scarring inflammation.
I wonder if the medication is causing this. He has not said anything about it being the Lialda, but my LFTs only started
going up after I started the Lialda.
Posted 6/23/2010 6:13 PM (GMT 0)
sucks. but at least now it's confirmed and you won't have to go through any more testing...poking, etc causing possible other problems.
What confirmed it.....PLEASE,PLEASE....get a copy of that report. It's important you have it. As well as any other tests you've had regarding PSC.

What amount of the URSO will you be on?

What scarring inflammation from the Lialda is in the info?

You need to deal with the colon inflammation, but maybe with rectal meds, you can lower the Lialda...or take ASacol??

Thanks for the update.

quincy
Posted 6/24/2010 3:22 AM (GMT 0)

If nothing else, it's coincidence with significance.

I don't know if the research you've read indicates that the elevated LFTs and scarring are reversible, but I might consider switching meds and re-testing to see if the LFTs return to normal.

My docs look at liver numbers every six months since they've been bouncing around.  They consider that time frame enough to indicate worsening or bettering of LFTs etc.  It might be worth a try.

Posted 6/24/2010 8:05 PM (GMT 0)
I am picking up the Urso tonight. Not sure on the dosage.

I meet with my doctor the end of july, so I am going to try and get copies of everything.
Plus I am going to ask if it is possible to try a different medication for the colitis.
I was on Asacol like 7 years ago, but I will give it another try.

And I am also going to start using Rowasa every few days.

I have read about a few cases where people with Cirrhosis got better, and never needed a transplant.

We will see, taking it a day at a time.

On a positive note, my wife is now 22 weeks pregnant with our first child. It's a boy! :)
Posted 6/25/2010 8:39 AM (GMT 0)
The med you're talking about is sulfasalazine...that could be an alternative for the Lialda. There's a thread about it...check it out, there are some links that might be helpful in your decitio nabout asking the doc.

Let me know what dosage of URSO you'll be taking. I've had no side effects, and after starting it my liver enzymes were back to normal.

Did the doc give you a 'script of the Rowasa? or did you have them already.
If you're not flaring, then every third night to start is a good thing to do.

Congratulations on your soon to be son!!! Hope the rest of your wife's pregnancy goes smoothly. When is she due?

quincy
Posted 6/25/2010 9:31 AM (GMT 0)
To the OP,

My liver functions tests have been up and down quite regularly. I have been on many medications and I always thought that its a result of neproxen that I take, at least 3 times a week for my migraine. Now the doctor thinks that its due to Azathioprine. Last week, I have liver ultrasound, just to rule out if anything is wrong with the liver anatomy. Nothing is wrong, alls fine. I have also had tests done to rule out hepatitis.

I hope your biopsy goes well and do stop by and let us know how it was done and its result.
All the best.
Posted 6/25/2010 4:49 PM (GMT 0)
He has PSC....conclusive apparently.
Posted 6/25/2010 5:04 PM (GMT 0)
Well Doc said it is consistent with PSC, which is also consistent with medication causing inflammation, Hep C.

I have had Ultrasound, MRCP which all came back fine.
The biopsy is the only thing that says there is something going on, well and my LFTs.

I have no symptoms.
Going to see if switching to a different medication and the Urso can bring my levels down.
My LFTs did not start to increase until I was the Lialda.

I am surprised my Dr never said anything about it possibly being my meds, he jumped straight to PSC.
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