The Hepatic System Q and A

The Hepatic System Q and A

The Hepatic System Q and A

The following questions and answers about Hepatitis C are related to Mini-Med School: The Hepatic (Liver) System.

Tests and Procedures
Question: How is scar tissue in the liver diagnosed? Ultrasound & Scan? Can ultrasound clearly show cirrhosis of the liver?
Answer: According to a March 2005 review article (15734925) in Radiology, various imaging methods to detect blood flow through the liver are available. Doppler ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) may all be used to determine scarring; each has advantages and disadvantages.

Question: Where do you go for the liver biopsy?
Answer: Liver biopsies are performed in a hospital.
  • A percutaneous (through the skin) biopsy uses the lower right side of the rib cage to gain direct access to the liver. First the area is injected with a numbing medicine. A special needle is inserted into your liver to get a tissue sample.
  • After the biopsy, you will need to lie flat on your right side for at least three hours before you can go home. You will be checked frequently to monitor for any signs or symptoms of bleeding.
  • A transjugular biopsy (sometimes called transvenous) takes about one hour and is done in the radiology department. Numbing medicine is injected into the neck area. Then a special catheter is placed into jugular vein in your neck to access the liver. Guided by x-ray, the tissue sample is taken and the pressure in the blood vessels of the liver is checked.
  • Liver biopsies may also be performed using a laparoscopic technique.
  • After the procedure the nurses will closely monitor you for about two hours.

For more information, visit the Health Learning Center and the National Digestive Diseases Information Clearinghouse (NDDIC) Web site.

Question: Can a blood test show that a person has been infected with Hepatitis C?
Answer: Several blood tests are used to determine exposure to HCV and degree of active infection. Each has a somewhat different purpose. You can read about each one by visiting the Lab Tests Online Web site.

Question: When receiving biopsy results, which is more important, the stage of fibrosis or the degree of inflammation?
Answer: The stage of fibrosis is more important than the degree of inflammation.

Drug Therapy
Question: For people with chronic pain of osteoarthritis, is there a pain medication that does not negatively impact the liver?
Answer: Many medications have the potential to harm the liver. It is important to work with your physician and pharmacist to take your medications appropriately.

Question: What does pegylated mean?
Answer: The term pegylated is derived from a group of chemicals called polyethylene glycols. Use of these substances in a medication has the advantage of causing the therapeutic effect to persist longer in the body than nonpegylated compounds.

Question: How does interferon work to keep HCV from replicating?
Answer: Although the exact mechanism is unknown, the prevention of replication is thought to happen through modulating the normal cellular response to infection or cellular inducers. This process can alter the immune response in the body.

Question: What is the next step for a partial responder after discontinuing treatment?
Answer: Your doctor will be the best source of this information, since everyone is different. General answers to your question can be found by visiting the Veterans' Administration Web site.

Question: Is the Interferon used to treat Hepatitis C patients the same as that used for multiple sclerosis patients? If so, does it work the same way in the immune system?
Answer: Yes, but there are several different types of Interferon on the market. Whether or not it works exactly the same way in the immune system is unknown.

Question: I understand from the presentation that the Interferon used to treat Hepatitis C can cure the disease in some patients. Does it have the same effect with multiple sclerosis patients? If not, why not?
Answer: Both multiple sclerosis and Hepatitis C are chronic diseases. Hepatitis C is considered cured if no HCV virus can be found with a PCR (polymerase chain reaction) test. Such success frequently does not occur in the United States, since Genotype 1, which along with Genotype 4 is the most difficult to treat, is the most common genotype in the United States. Other factors that mitigate treatment success include race (African-Americans respond much more poorly to treatment than nonblacks); high viral load; male gender; weight above average or obese; and severe cirrhosis.

Unfortunately, no cure is presently available for multiple sclerosis, though researchers all over the world are working on this problem.

Alternative/Complementary/Integrative Therapy
Question: What other herbal therapies-other than milk thistle-are suggested?
Answer: According to information from the Natural Medicines Comprehensive Database, there is presently no evidence for effectiveness of any substance in the treatment of liver disease. SAMe is rated as possibly effective; alpha-lipoic acid is possibly ineffective for alcohol-related liver disease, and there is insufficient evidence to rate the use of milk thistle to improve liver function tests and decrease mortality in alcohol-related liver disease.

For Hepatitis C, however, the database rates Lactoferrin as possibly effective when the dose is sufficient. Additionally, phosphatidycholine taken orally in the polyunsaturated form, combined with interferon, is possibly effective for reducing liver enzymes in patients with chronic Hepatitis C.

St. John's wort is rated as possibly ineffective for Hepatitis C. Both European mistletoe and milk thistle are listed as having insufficient evidence to rate them for efficacy against Hepatitis C infection.

More information on these substances may be obtained from the Health Learning Center. As always, check with your doctor before taking any herbal or supplement.

Symptoms and Manifestations
Question: If there is a little scarring on the liver, is that a bad sign of future cirrhosis?
Answer: According to Taber's Cyclopedic Medical Dictionary, cirrhosis actually means scarring of the liver. The scarring, or cirrhosis, results in a progressive loss of function in the liver cells, impairing blood circulation and filtering of impurities within the organ.

Question: Does blood in the stool mean you have cirrhosis of the liver?
Answer: Not necessarily. Blood in the stool can be a sign of many different diseases and should always be checked out by a physician.

Question: Can cirrhosis symptoms such as muscle wasting or confusion from alcohol use improve over time if alcohol is stopped?
Answer: Yes, sometimes, but it depends on the individual case.

About Hepatitis C
Question: IS Rh-negative blood a form of Hepatitis C?
Answer: No, the RH factor has nothing to do with Hepatitis C infection.

Question: Have acupuncture needles been implicated in HCV?
Answer: Three reports of Hepatitis B or C transmitted through the use of acupuncture therapy exist in the medical literature; however, none occurred in the United States. So yes, acupuncture needles have been implicated in the transmission of HCV.

Question: Does Hepatitis C cause damage in any organ besides the liver?
Answer: Hepatitis C affects the liver initially but eventually may lead to problems with other body systems because of the compromised ability of the liver to filter impurities from the blood.

Question: What are the long-term effects of newborns with jaundice, and why are they born so?
Answer: According to information on Lab Tests Online, high bilirubin levels, or neonatal bilirubin, occur in up to 50 percent of full-term newborns and an even higher percentage of premature infants. This occurs because newborns lack the intestinal bacteria that help to process bilirubin. The situation generally resolves within a few days. Very rarely, up to the age of two to four weeks, brain development may be affected. However, early treatment can prevent any long-term ill effects. For more information, visit Lab Tests Online.

Question: How many "lettered" forms of hepatitis are there? Other that A, B, AND C?
Answer: The Centers for Disease Control and Prevention list five viral hepatitis diseases: A, B, C, D, and E.

Question: Why are people on dialysis at increased risk for Hepatitis C?
Answer: Transmission of HCV to long-term hemodialysis patients is thought to occur primarily because of lapses in strict infection control procedures within the dialysis unit. Other risk factors include the number of blood transfusions the patient has received and the length of time a patient has been diagnosed with kidney failure, or end-stage renal disease. It should be noted that both the incidence and prevalence of HCV infection among patients in the hemodialysis population is declining steadily. An article about this topic, "Contamination by Hepatitis B and C Viruses in the Dialysis Setting," is available in the Health Learning Center.

Question: I have heard that getting Hepatitis C when young translates into more serious illness. Is this true?
Answer: No, not necessarily.

Question: Can the mutations that happen in the virus not be detrimental to it and even possibly kill it?
Answer: Perhaps. Such a scenario is theoretically possible. However, it is almost impossible to design a study to test the theory, so at least for now, we may never know.

Question: Since human beings have innate adaptive immunity, (1) can our immune system fight off the virus? and (2) does our adaptive immune system ever catch up to the RNA-producing proteins, or is just dependent on one's genetic makeup?
Answer: Immunity is multifactorial and very difficult to predict. It is certainly possible that an individual's immune system could fight off the HCV infection. However, it is far more likely that it could not.

This question is analogous to a few people in the world who have been exposed to HIV but who remain healthy, with no detectable viral load. Scientists have recently discovered some genetic information in Caucasian populations that predisposes them to a higher susceptibility to HIV and, if infected, faster disease progression. There are other factors as well that are being studied, but you can learn more about the genetic discovery by visiting the National Institutes of Health Web site.

Question: Is there a locus for HCV, like there is for Herpes? If so, where is it?
Answer: No, there is no such locus.

Question: Does one have to be treated for Hepatitis C and cirrhosis, especially if symptoms are mild?
Answer: Treatment decisions are made on an individual basis between physician and patient.

If you have further questions, contact the Health Learning Center at 312-926-5465 or ask your health-care provider for clarification.