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Please, Please, Please help me understand BIopsy results!!!
Aug 2, 2004

Dear Dr.Dieterich, I wrote you on July 20 after I had just found out I had cirrhosis due to Chronic Hep B. I didnt have the official results from the biopsy at that time but I do now. The biopsy says..... Chronic Hepatitis B, Grade 4, Stage 4(micronodular cirrhosis) COMMENT: THe normal architecture of the liver is distorted by fibrous bands which separate the parenchyma into nodules. This is best seen on the trichrome stain. In addition, there is moderate fatty change noted. Within the fibrous tissue a severe degree of chronic inflammation is noted with piecemeal necrosis seen. Foci of lobular necrosis are also noted. There findings are best demonstated on the PAS, with and without diastase stains. The reticulin stain demonstrates collapse of the reticulin framework. Stainable iron is absent. Pertinent laboratory findings are elevated liver function tests and chronic hepatitis B serology by history. My doctor said he thinks its something else aside from Hep B because I had an HBV DNA by PCR test done 2 months ago which was non detectable. He said he needs to talk to another doctor about it or look at the biopsy sample himself. All my LFTs I took the day before my surgery (gallbladder removed because of stones) were normal exept my Ast 63 and ALT 56. I feel fine exept I think the stress of just finding out is causing me to start feeling sick because I felt fine before the surgery and the biopsy findings. Now Im feeling scared, dizzy, and sick to my stomach(the last day or so). Every little thing I feel now I think its my liver. I am making myself sick with worry. I am a widow with 2 daughters (3 and 14) and I am so scared, sad and upset. I dont drink but am overweight which I know doesnt help my liver. Can you please tell me what my results mean, and what questions I can ask my doctor. Also what kinds of medications would help stop the progression of this? Like I said I havent felt any symptoms at all. How long can a person have cirrhosis until they finally start feeling the symptoms? Do you know of any good Hep. doctors in the So. Cali area (L.A. or Orange County) that takes Medical? Please help me Dr. I feel soooo lost and alone!! Thank you for your time!!

Response from Dr. Dieterich

First make sure your MD is checking your hepatitis B by HBV DNA PCR. If it is negative then the answer is probably fatty liver disease or NASH. It is the fourth leading cause of liver transplant and is a little appreciated cause of liver disease in the US. NASH is increasing everyday as a consequence of the epidemic of obesity in the US. Lose weight and ask your MD to check your insulin level when you are fasting. The medical schools at UCLA, and USC have very good liver programs if you need them to accept your medicaid. Good luck! DTD



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