It's here!

At last – the clinic letter from Birmingham has arrived! It was worth the wait just for the sentence “Hannah is lovely [not very medical, but who cares] and is really very well compensated.” Compensated, in terms of liver disease, means that although the liver is damaged, it is functioning normally. Decompensation is when the liver begins to lose its function.

So, here is the long awaited ultrasound report, described by Dr McKiernan as “fine”, which will do very nicely, thank you.

Comparison has been made with the last scan dated 11.10.04. The liver is now slightly coarse in echotexture. No biliary dilatation. The PV measures 7.1 mm at the liver edge and has a flow of 31.6 cm/s into the liver. The HVs, IVC and SV are patent with normal directional flow. The hepatic artery RI = 0.69. The spleen is enlarged measuring 10.7 cm in length (previously 7.0 cm). No obvious spleno-renal shunt noted. The midline structures are obscured by overlying bowel gas. Both kidneys are normal. Right renal length = 7.3 cm (55th centile), previously 5.6 cm. Left renal length = 7.2 cm (55th centile), previously 5.9 cm. Normal urinary bladder. No free fluid.

Right, so overall this is good, and here is my attempt at interpretation:

The liver is now slightly coarse in echotexture Not great, this is indicative of a damaged liver, but at least it is only slightly.

No biliary dilatation I think this is good, and assume it means her bile ducts are not dilated.

The PV measures 7.1 mm at the liver edge and has a flow of 31.6 cm/s into the liver PV = Portal Vein. I haven’t found any normal values for this, but I think this is pretty good. If the portal vein flow is too slow, this is what causes portal hypertension.

The HVs, IVC and SV are patent with normal directional flow This is obviously good as it contains the words patent and normal. I’m guessing that this is about blood flow, and thinking that HVs = Hepatic Veins, IVC = Inferior Vena Cava, SV = Superior Vena [Cava].

The hepatic artery RI = 0.69 RI = resistance index. I think that this is good, although have not managed to find out much about it apart from above 1.0 or below 0.5 is bad.

The spleen is enlarged measuring 10.7 cm in length Not great, as this is the spleen size for a 10 year old child.

No obvious spleno-renal shunt noted Good; new pathways are not forming to cope with restricted blood flow.

The midline structures are obscured by overlying bowel gas The last US said this too, and I still have no clue what it means.

Both kidneys are normal. Right renal length = 7.3 cm (55th centile), previously 5.6 cm. Left renal length = 7.2 cm (55th centile), previously 5.9 cm. Normal urinary bladder Obviously good.

No free fluid No ascites, so good.

So, no nasty surprises lurking inside then! It feels very good to look at Hannah and know that what I can see on the outside is not too far off what is happening inside. I am very thankful that there is no diagnosis of portal hypertension.

Of course, being me, I am still left with questions, and things I would like to know more about. How is Hannah’s spleen so enlarged without being detectable by physical examination? I thought it followed the same rule as the liver, that it should match up with the bottom of the ribcage; and if it can be felt, then it is enlarged and vice versa. I also thought the enlarged spleen was a symptom of portal hypertension, which she does not appear to have. Could she have had PH when her liver was more inflamed when she was younger, which then resolved when the inflammation went down? I’m also keen to properly understand the portal vein flow and hepatic artery numbers; I just can’t help myself. I will be asking those questions of my knowledgeable buddies over at Liver Families.

The follow up at Birmingham will be next summer; no ultrasound scheduled, so there is plenty to smile about.

BIG sigh of relief.