Chapter 5 - Liver Anatomy and Liver Tests
Most of us take our liver for granted, mostly because we don’t know anything about it until we have some crazy disease that is attacking it. I know I did!
Organ’s purpose
The liver’s function is to filter nutrients, bacteria, viruses, molds, and toxins. It also generates cholesterol to “feed” various nerve and soft tissues throughout the body.
The liver can regenerate itself fully in six months and is one of the only organs in the human body that can do this (like a salamander growing back a lost leg). Even if you were left with only a small portion of liver, it has the ability to totally regenerate to the full organ once again. This is one of the reasons HCV takes so long to cause death or cancer, the liver is constantly dying and regenerating never allowing the virus to get to comfortable for very long. Of course, as you get older the regeneration process slows and the virus is able to gain a stronger foothold.
Relationship between liver and heart disease
Besides filtering various toxins and such, the liver functions as a major processing center using special enzymes to break down all sorts of chemicals like alcohol. One of the major molecules that the liver produces is cholesterol. In fact, the liver produces hundreds of times more cholesterol in a day than you would get by eating a stick of butter straight up.
Heart disease is less about what you eat and more of a liver problem. Think of the liver as a structure that is similar to the cellular structure of a sponge with very tiny holes. Unfortunately, these holes tend to get blocked by gallstones. Gallstones are mostly made up of dead parasites mixed with various proteins, fats, and bile. These stones block the larger LDL cholesterol (otherwise known as “bad cholesterol”) from exiting the liver. This causes the other LDL cholesterol to back up in the blood stream and coat the walls of your arteries.
Level of severity
Mild damage
Mild liver damage is common in most hepatitis cases. At this point some of the liver cells are dying at an accelerated rate, but there is not any scaring. Mild damage is called Stage 1 damage.
Fibrosis
Fibrosis is the initial scaring of the liver structure. Scaring is caused when the liver tries to repair itself, but an imbalance of cell type causes abnormal structures that begin to function improperly. Stage 2 liver damage is the beginning of scaring fibrosis. Stage 3 liver damage is the point where fibrosis begins showing some permanent damage.
Cirrhosis
Cirrhosis is the point past fibrosis; the liver is dying. Many texts state that this stage is irreversible. This is true if the whole liver is cirrhotic, but in most cases you do have some salvageable cell structures. And there have been a few cases where the liver was able to reverse this type of damage. In most cases, cirrhosis is considered a death sentence, but not always.
HCV Tests
Liver Panel
A liver panel is a blood test used to check the enzyme levels that mainly come from the destruction of liver cells. There are two types of enzymes that your doctor will check to see if you need an HCV Antibody test. The two enzymes in particular are ALT (SGPT) and AST (SGOT)…these two enzymes are released into the blood stream every time a liver cell dies. Once your enzyme levels are above the normal range, you will be asked about your consumption of alcohol, use of recreational drugs and/or checked for HCV. They will also use this same test to review your progress if you choose to go through the peg-interferon treatment. Normal range for ALT enzymes is 7 to 56 units per liter. Normal range for AST enzymes is 5 to 40 units per liter.
HCV Antibody Test
An HCV Antibody test is done when a liver panel blood test comes back above the normal range. It is designed to detect your body’s immune response to being exposed to HCV. Sometimes this test can produce false positive results, so if it comes back positive the doctor will usually do a PCR test to verify that there is actual HCV genetic material. This will also give him/her an initial count of viral material per milliliter of blood, which is also called viral load.
PCR Test
PCR test is also known as a polymerase chain reaction - as previously stated it is used to look for active RNA viral material of HCV.
HCV viral genotyping
The viral genotyping test is used to identify which type of hepatitis C virus you have been exposed to…this information is used to determine how your infection will be treated. Treatment is usually six months if you have a genotype 2 or 3. All other genotypes are treated for 12 months. Genotypes 1a and 1b are most common in the United States.
Biopsy Test
Once the doctor has verified that you have HCV, he/she will order a liver biopsy. A biopsy is a medical procedure where the doctor will take a tiny sample of your liver. This is an outpatient procedure that takes about five hours of your day. The procedure itself is about two minutes long. Unfortunately you have to stay under medical supervision for about four hours after the procedure before being released. The medical staff wants to make sure that you don’t bleed internally after the doctor takes the sample.
The procedure it very simple, you sign in at the hospital, the nursing staff prepares you by getting you comfortable, taking off your shirt (and bra if you are female). Next the doctor will come in with a long instrument and a syringe with a local anesthetic. He/She then look to mark a spot between the ribs on your right side. The doctor will then insert the syringe with the local anesthetic. To be honest I found this to be more uncomfortable than the biopsy itself…it felt like someone was pumping a small bit of thick liquid under my skin. It didn’t hurt, just felt kind of icky. The doctor will give the anesthetic about a minute to take effect then quickly insert the long needle instrument into the marked area. You will hear a click. Then he/she removes the instrument; the procedure is over in less than ten seconds. The nurse applies a gauze pad and they roll you over on your right side.
This may sound scary, but believe me it’s really not that bad. Make sure you bring something to read or some music to listen to for after the procedure, lying in bed on your right side for four hours is pretty boring!
Is their a cure?
After being diagnosed, I became very apprehensive and depressed because almost every website and piece of medical literature I read basically scared the crap out of me by saying there is no cure. I tend to disagree…So do I think there is a cure then?
The short answer is, yes and no. How can that be? Well like almost any virus that can be treated today, there are currently no magic pills you can take and find yourself suddenly cuvred the next day or week or month. Your cure actually relies totally on how your immune system is able to capture and destroy the infection.
Sometimes being “cured” is considered viral remission or SVR (Sustained Viral Responder). This is a pharmaceutical company’s way of having a legal out if you end up with it again later on in life. From my experience, I believe that the longer you give your body the upper hand, the more permanent your positive treatment will be.
Go to Chapter 6 - What Are Your Current Options (for Hepatitis C Treatment)?
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