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  • JJ - Cirrhosis/Fibrosis Scale

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    Old 08-07-2002, 03:48 PM   #1
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    JJ - Cirrhosis/Fibrosis Scale

    Hey JJ-
    This is a chart, which you cant see but explains, stage four being cirrhosis and stage two only being moderate fibrosis, if this is clear as mud I can find more.
    Neil **************************************** *************** Scoring Systems for Staging of Chronic Hepatitis
    **************************************** ***************
    Various scoring systems are used to evaluate the amount of fibrosis in chronic hepatitis.

    Score Description Knodel Sciot and Desmet
    (unpublished) Scheuer
    0 No fibrosis No fibrosis None None
    1 Mild fibrosis Fibrous portal
    expansion Periportal fibrous
    expansion Enlarged,fibrotic
    portal tracts
    2 Moderate fibrosis (blank) Porto-portal septa
    (> 1 septum) Periportal or portal-portal septa,
    but intact architecture
    3 Severe fibrosis Bridging fibrosis
    (portal-portal or
    portal-central linkage Portocentral septa
    (> 1 septum) Fibrosis with architectural
    distortion, but no
    obvious cirrhosis
    4 Cirrhosis Cirrhosis Cirrhosis Probable or definite
    cirrhosis

    From: Desmet: Hepatology <IMG SRC="http://www.healthboards.com/ubb/frown.gif">1994) 19:1513; Knodell: Hepatology <IMG SRC="http://www.healthboards.com/ubb/frown.gif">1981) 1:431; Scheuer: J Hepatology <IMG SRC="http://www.healthboards.com/ubb/frown.gif">1991) 13:372


    --------------------------------------------------------------------------------


    HAI (histological activity index) by Knodell


    I. Periportal +/- Bridging Necrosis [Score]

    A. none [ 0]

    B. mild piecemeal necrosis [1]

    C. moderate piecemeal necrosis (involve less than 50% of the circumference of most portal tracts) [3]

    D. marked piecemeal necrosis (involve more athan 50% of the circumference of most portal tracts) [4]

    E. moderate piecemeal necrosis plus bridging necrosis plus bridging necrosis [5]

    F. marked piecemeal necrosis plus bridging necrosis plus bridging necrosis [6]

    G. multilobular necrosis [10]

    II. Intralobular Degeneration and Focal Necrosis

    A. none [0]

    B. mild (acidoplhilic bodies, balooning degeneration and/or scattered foci of hepatocellular necrosis in &lt; 1/3 of lobules or nodules) [1]

    C. moderate (involvement of 1/3 ~ 2/3 of lobules or nodules) [3]

    D. marked (involvement of &gt; 2/3 of lobules or nodules) [4]

    III. Portal Inflammation

    A. no portal inflammation [0]

    B. mild (sprinkling of inflammatory cells in &lt; 1/3 of portal tracts) [1]

    C. moderate (increased inflammatory cells in 1/3 ~ 2/3 of portal tracts) [3]

    D. marked (dense packing of inflammatory cells in &gt; 2/3 of portal tracts) [4]

    IV. Fibrosis

    A. no fibrosis [0]

    B. fibrous portal expansion [1]

    C. bridging fibrosis (portal-portal or portal-central linkage) [3]

    D. cirrhosis [4]
    From Knodell RG et al.; Formulation and application of a numerical scoring system for assessing histological activity in asymtomatic chronic active hepatitis. Hepatology, (1981) 1:431



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    Old 08-07-2002, 09:31 PM   #2
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Neil,
    ok...one question...what is the difference between fibrosis and cirrhosis? You are pritty deep...my husband and I are trying to figure this thing out...thanks for the info,....
    jj

     
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    Old 08-08-2002, 07:36 AM   #3
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Bless you Neil. I have been trying to figure out what stage I am in and this tells me I am in Stage 1. And thats good news??!!

    Thanks,
    Jeannie

     
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    Old 08-08-2002, 09:13 AM   #4
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Hi JJ-
    Ok let me explain it to you the way I understand it-

    FIBROSIS- is the development of excessive fibrous tissue which may cause, and is caused by damage and scarring, caused by diease or alcohol, in HCV the scale is 1-4, one being minor stage, 4 meaning trouble, as the liver has reached Cirrhosis, fibrosis is the stages of your liver being damaged.

    CIRRHOSIS - is the stage when the liver is permently damaged,injured and scarred, it gets inflammed and does not function properly, leading to liver transplant, I seen a liver with cirrhosis,it was swelled up twice its size, puffy, inflammed, bright pink, and looked more like lungs,nasty.

    OSIS - Means the process or condition- ie- Fibro-osis Cirrho-osis

    HCV - damages the liver in stages 1 - 4, by scarring and inflamation, by that nasty virus, when we reach stage 2, many have to make the decision on whether or not to treat with drugs,to prevent further damage, which YOU are doing, NOW, if, as we all hope, you kill the Dragon virus, the damage stops, at that stage.

    Now some think, well if I cure this, I can drink alcohol again, well that damage is irreversable, you will still have to take care of yourself to prevent futher damage, a person whom, say, was stage two HCV, took the meds and was virus free, then went back drinking alcohol, may still develop Cirrhosis from damage done by the alcohol.- Nasty stuff on our livers that Dragons Blood, [Alcohol].

    Clear as mud?


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    Old 08-08-2002, 09:14 AM   #5
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Hey Jermah- yes that is great news, as you have read above, you want to stay at stage 1.

    --Get Outdoors-Enjoy Life----Neil<p>[This message has been edited by LOST1 (edited 08-08-2002).]

     
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    Old 08-08-2002, 09:54 AM   #6
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Neil,
    I could kiss you....I wish my doctors could talk such plain english...they kept saying I was in Cirrhosis. I kept telling my husband that I am in fibrosis not cirrhosis....My doctor said they will want to keep me on treatment for maybe an extra year because of cirrhosis....does treatment help people who are in cirrhosis? by your opion do yo think I should stay on treatment an extra year....just in case...(as the doctors say) The treatments are going fine....I feel like one of the lucky ones...It's three months this saturday...only 9 more to go...shoot I can do that..I was pregnant and naseated for 9 months of pregnacy..and I did that 3 times....Get behind me saten....I am busy slaying a dragon....God bless you and THANK YOU for all your input...I will be praying for you and your dececion for treatment when it comes out...jj

     
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    Old 08-09-2002, 08:33 AM   #7
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Hey JJ-
    Anytime- on the info,
    -I don't think someone with full blown cirrhosis could handle a treatment, would be time to think about transplanting,- to be honest with you I never heard of anyone being on the treatment for an extra year if your talking about the Interferon/combo your taking,I am not sure that is a good idea, I would think that would cause an great amount of stress on your whole body, second opinion time?.
    And hell ya, if you can handle nine months of pregnacy, this should be a "tip toe though the tulips" for you,ha ha.
    Three months went by pretty quick huh, the rest will go quicker as it will become routine[treatments] for you, your going to whop this dragon.


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    Old 08-09-2002, 09:10 AM   #8
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Cirrhosis is a stage of scarring where it was once thought the scarring itself was totally irreversible. We know now that, in some instances, it may be reversable by Pegasys. This is one of the things that makes this drug exciting and different. It targets the liver specifically instead of scattering interferon everywhere in the body.

    But back to cirrhosis in general...cirrhosis is NOT end stage liver disease. It is not the time to put someone on a transplant list. Not even close. There are some very healthy people walking around with early stages of cirrhosis (which, by the way has a scale of its own)

    In broad terms, though, cirrhosis falls into two distinct classifications and here is where most confusion occurs. Compensated cirrhosis means the liver is still functioning quite well and it is managing to perform liver functions adequately. These folks can be treated, all things being equal.

    Decompensated cirrhosis is when you begin to realize serious symptoms that MAY lead to a transplant evaluation. Even then, there are grades and categories to be assessed for. Treatment for these folks is not indicated because the liver is now fragile.

    Bottom line is this: even with cirrhosis a person can expect to live a very full life. Care of oneself is now critically important and missteps by alcohol use, smoking and drug use (legal or not) will cost the liver some vitality. You can be treated, it can work to clear the virus (though the cirrhosis will remain in almost everyone) AND new data is showing that Pegasys can reverse the damage up to one stage. At this point if a person can undergo treatment, they really should consider it. In fact, if lifestyle changes have not stopped the progression, treatment should really be considered once progression is demonstrated.

    This is not yet an exact science, unfortunately and controvesy surrounds most of these issues.

    Do your own research and realize you are in control of your own decisionmaking. These are general statements and are not meant as medical advice.

    The other point worth mentioning is that treatment does not cause reversal of damage in many people. You may test negative for the virus, but the damage is done. Care of oneself is vital upon diagnosis to ensure that progression does not take place. This is why viral load really isn't a good measure of status.

    Remember, only 2-3 people out of 100 will progress to complications of HCV. This does not refer to progression to cirrhosis. Lots of people develop cirrhosis and live well and never have serious (life threatening)complications. But sadly, many continue to progress and quality of life diminishes.

    Neither HCV nor cirrhosis are death sentences. But they can be if they are not addressed appropriately.

    I hope this helps,

    thanbey


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    Old 08-09-2002, 03:32 PM   #9
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Thanks...reading the board kinda alows me to take a deep breath and exhale...we get so tied up in it...time to put the hep c aside the mind for awhile..it's hard when your on treatment because its hard not to remember what your dealing with...thanks for good information and HOPE....sometime we all just need to hear it again...God Bless...jj

     
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    Old 08-09-2002, 03:50 PM   #10
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Howdy mrs. Thanbey-

    when I spoke of "full blown" cirrhosis I meant decompensated cirrhosis , but used "full blown" as a understandable term, and only mentioned it was time to start to "think" about transplants,
    Also have you ever heard of someone being on a treatment as JJ mentioned for a extra year after the first year? thats new for me, would like to hear more on that.
    Always love your input.




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    Old 08-09-2002, 07:36 PM   #11
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    Re: JJ - Cirrhosis/Fibrosis Scale

    I have heard of treatment going out 18 to 24 months. I do not believe that this is in combination with ribaviron, though.

    There is now research into small dose "maintenance" dosing for those who are progressing in spite of every effort to contain progression. This is rare. But, people with cirrhosis may benefit. Still experimental.

    All the best to you, Neil. Been mushrooming yet this year? I miss my visits to the farms in rural Alberta. It's where my mother's people are from and I spent many a summer in those parts.


    thanbey



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    Old 08-09-2002, 11:50 PM   #12
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    Re: JJ - Cirrhosis/Fibrosis Scale

    I have stage4 grade3 type 1A What does that all mean?

    Thank You

    Glenn<p>[This message has been edited by Glenn43 (edited 08-10-2002).]

     
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    Old 08-10-2002, 07:43 AM   #13
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    Re: JJ - Cirrhosis/Fibrosis Scale

    Hi Glenn,

    It means you need to have a discussion with your doctor
    about whether you are appropriate for treatment. Your goal is getting a result for improved histology (liver condition) rather than viral load, so if you can't tolerate ribaviron, you may consider montherapy (Infergen, Pegasys when it is available, or Roferon until it is)

    If you and your doctor decide to treat with the available medications, don't worry too much about the viral load and do not stop at 12 weeks if you tolerate the medication well but do not achieve a negative viral load.

    It means you should never have another drop of alcohol or smoke anything ever again. Watch over the counter medications and avoid exposure to toxic chemicals (the air alert days apply to you)

    It is possible for someone with this biopsy result to live a long full life, but you have no wiggle room when it comes to caring for your health. None. If you are not fit and healthy, it is time to get as fit as you can and take steps to be as healthy as possible.

    While about 20% of those with HCV will progress this far, only 2-3% will actually die of the complications. It isn't good news, but it isn't the worst news, either. You can do something to increase your own well-being.

    Of course, your chances of living well depend totally on how you take care of yourself and what choices you make now. While that is true for us all, it is particularly good advice for you.

    Again, you and your doctor need to have a discussion that includes all of your options, your medical tests (stress test!)and your goals for treatment. Only you and your doctor have all the information necessary to make this decision. I can tell you about the research and about the mediications, but I do not know you and I am not a doctor.

    I hope this helps,

    thanbey

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