Diffuse Liver Fibrosis: When to Seek Further Evaluation

Q: Diffuse Liver Fibrosis: When to Seek Further Evaluation

Reply： Hello, regarding hepatitis, in Taiwan, chronic hepatitis B and C are still the most prevalent, particularly in the Chiayi and Tainan regions. <br>When liver enzymes (AST/ALT) are elevated, it is essential to test for HBsAg (Hepatitis B Surface Antigen) and anti-HCV Ab (Hep

"Diffuse" liver fibrosis

Dear Dr.
Li,
Hello! My mother is 82 years old and had breast cancer surgery five years ago (without chemotherapy).
She has diabetes, hypertension, and hyperlipidemia.
She has been tested negative for hepatitis B, but has not been tested for hepatitis A or C.
A few years ago, she experienced abnormal liver function and took liver medication prescribed by Chiayi Saint Martin Hospital for over a year until her liver function returned to normal (ultrasounds have been normal each time).
Since it has been normal, she has not had any checks for over a year.
Recently, she went to a nearby clinic for a check-up, and the results showed slightly elevated liver function.
The ultrasound appeared hazy, and the doctor mentioned it could be liver fibrosis, but did not definitively rule out liver cancer.
When I asked if we should seek a CT scan at a larger hospital, the doctor suggested just to observe and check again in three months.
The doctor also mentioned that given my mother's age and health, even if something serious is found, she may not be able to tolerate further treatment.
I am not convinced and sought a second opinion at another clinic, which also noted a hazy area, possibly indicating diffuse liver fibrosis, but likely not liver cancer, as liver cancer typically does not present bilaterally.
They also recommended just to observe for three months.
Neither clinic prescribed any medication, leaving me uncertain about what to do.
It seems somewhat serious, yet it also feels like it might not be.
Should we go to a larger hospital for further examination, or is it acceptable to just observe for three months? I would appreciate your insights.
Thank you!

yoyo, 50~59 year old female. Ask Date: 2011/10/08

Dr. Li Yongming reply Gastroenterology and Hepatology

Reply: Hello, regarding hepatitis, in Taiwan, chronic hepatitis B and C are still the most prevalent, particularly in the Chiayi and Tainan regions.
When liver enzymes (AST/ALT) are elevated, it is essential to test for HBsAg (Hepatitis B Surface Antigen) and anti-HCV Ab (Hepatitis C Antibody) as preliminary screenings for viral hepatitis.
However, under the current health insurance review system, if HBsAg or anti-HCV Ab is tested without cause, it may be disallowed.
Therefore, please bring your mother's abnormal liver enzyme report to a hepatobiliary specialist for further evaluation.
Currently, the consensus among health insurance reviewers is that for patients with chronic hepatitis B or C, if liver enzymes (AST/ALT) are elevated, liver protectants can be prescribed; however, for hepatitis caused by other reasons, liver enzymes must exceed twice the normal value to qualify for prescription.
Under the intensified scrutiny of health insurance, medications cannot be prescribed if they do not meet the criteria.
Some medical studies indicate that certain liver protectants may reduce liver enzyme levels, but this only addresses the symptoms and does not treat the underlying cause.
Whether or not one is taking liver protectants is not clinically significant.
As for liver fibrosis, it is understood that it results from the liver undergoing chronic inflammation, leading to regenerative tissue formation.
When liver inflammation is severe and exceeds its repair capacity, fibrous tissue is formed to provide support, resulting in a loss of normal elasticity, making the liver feel hard like a stone.
Over time, this can lead to cirrhosis.
The gold standard for diagnosis is a liver biopsy, with the final determination made by a pathologist.
Clinically, ultrasound is used as an initial screening tool.

Reply Date: 2011/10/08

More Info

When it comes to diffuse liver fibrosis, especially in elderly patients with a history of other health issues, it is crucial to approach the situation with a comprehensive understanding of the underlying conditions and the implications of the findings. In your mother’s case, the presence of a "hazy" appearance on ultrasound and slightly elevated liver function tests could indeed suggest some degree of liver fibrosis. However, it is essential to differentiate between various potential causes of liver abnormalities, including fatty liver disease, chronic hepatitis, or even the effects of her other medical conditions such as diabetes and hypertension.

Firstly, the term "coarse echo pattern" observed in ultrasound imaging can indicate changes in liver architecture, which may correlate with fibrosis. However, it is important to note that ultrasound is not definitive for diagnosing fibrosis. While it can suggest the presence of fibrosis, it cannot quantify its severity accurately. For a more precise assessment, non-invasive methods such as FibroScan or even a liver biopsy may be warranted, especially if there is a concern about the progression of liver disease.

Given your mother's age and medical history, including her previous breast cancer and current chronic conditions, the decision to pursue further evaluation should be carefully weighed. If her liver function tests are only slightly elevated and she is asymptomatic, the recommendation to monitor her condition for a few months may be reasonable. However, if there are any concerning symptoms—such as jaundice, significant abdominal pain, or changes in mental status—immediate evaluation would be necessary.

In terms of follow-up, it is generally advisable to have regular monitoring of liver function tests and imaging studies, especially in patients with risk factors for liver disease. If the follow-up ultrasound continues to show abnormalities or if liver function tests worsen, further evaluation should be considered. This could include more advanced imaging techniques like a CT scan or MRI, which can provide more detailed information about liver structure and any potential lesions.

Moreover, it is essential to consider the overall health status of your mother. If she is stable and her other chronic conditions are well-managed, the risk of significant liver disease may be lower. However, if there are any doubts or if you feel uncomfortable with the current management plan, seeking a second opinion from a hepatologist or a liver specialist at a larger medical center could provide additional insights and reassurance.

In conclusion, while the current approach of monitoring may be appropriate given the circumstances, it is crucial to remain vigilant. If there are any changes in her health status or if you have ongoing concerns, do not hesitate to advocate for further evaluation. Early detection and management of liver disease can significantly impact outcomes, especially in patients with complex medical histories.

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