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| | Title: | What is Liver Biopsy? | | Article: | When your liver does not work properly, your doctor
may suggest liver biopsy.
Liver biopsy means that a small piece of tissue from
your liver is taken for study. Usually the biopsy is
taken by a doctor, who is using a special needle.
The reasons to get liver biopsy include: blood test
showing increased liver enzymes, overload with iron or
copper, symptoms of chronic hepatitis. Basically,
getting a sample of liver tissue is the advanced
option to find what the cause of the liver damage is
and to check if your treatment improves the liver
condition. Though, the biopsy gives significant
information about the problem and considered the
standard of practice, it is usually not the first
choice when you go to your doctor. Various criteria
should be met. The guidelines for liver biopsy
include: the ability of the patient return to the
hospital during 30 minutes after any complications,
absence of serious medical problems, presence of an
approved laboratory, and staff to monitor the patient
for 6 hours after the biopsy.
The information must be useful for good patient care.
Usually, doctor expects to clarify the cause of the
liver damage, the degree of injury, the extent of
damage, quality and quantity of inflammation and
fibrosis.
Liver biopsy may be done in an outpatient clinic or
in-house. The medical staff should be experienced. The
patient must stop coumadin and other anticoagulants,
e.g. aspirin, or other anti-clotting medication a week
before the procedure.
Since the major risk is uncontrollable bleeding,
anything that prolongs bleeding time serves as a
contraindication to liver biopsy. This includes:
history of bleeding, increased prothrombin time, low
platelet count, prolonged bleeding, liver vascular
tumor, echinococcal cysts in the liver, hemophilia,
etc.
Also, anything that makes procedure more dangerous
could be a contraindication: absence of blood
available for transfusion, non-cooperative patient,
significant obesity, ascites.
Some of the listed problems may be corrected before
the procedure by using additional measures.
A patient gives an informed consent and is placed
flat. Sometimes the doctor gives sedation.
The skin is locally anesthetized, and the liver
biopsy is performed. Doctor quickly inserts and
withdraws a long needle into the liver. The piece of
the liver is approximately 2-3 cm long and has the
diameter of the needle.
After biopsy you lie on right side. Doctors check
blood pressure and heart rate.
Some centers consider liver biopsy as minor surgery
and perform it at the hospital.
Doctors may use an ultrasound to guide the needle. Two
more methods may be used: laparoscopic biopsy, when a
thin tube helps to watch the liver and transvenous
biopsy that is used when patient has ascites.
You should arrange for somebody driving you home. You
must stay in bed for a day, depending on doctor’s
instructions. Risks of liver biopsy include accidental
lung puncture infection, pain, bleeding. You should
avoid anti-coagulants for a week after procedure. Also
avoid heavy lifting and exercise for a while to allow
the puncture to heal.
What do they look in the liver samples?
Liver biopsy is evaluated for fibrosis, inflammation
and necrosis (amount of dead tissue). Inflammation is
assessed by looking for mononuclear cells and
lymphocytes. Fibrosis is the development of fiber-like
tissue. Bridging fibrosis characterize advanced
stages. Cirrhosis is sort of significant bridging
fibrosis with regeneration that distorts normal liver
architecture by widespread nodules. Cirrhosis happens
in the late stages of liver disease. Basically,
cirrhosis is the widespread scarring of the liver.
Check More Information at:
American Liver Foundation
www.liverfoundation.org
Symptoms check on-line
www.rdoctor.com
Hepatitis Foundation International
www.hepfi.org
Centers for Disease Control and Prevention
www.cdc.gov
United Network for Organ Sharing
www.unos.org
The samples of liver are processed in the lab and
checked under microscope. The degree of damage is
assessed by different systems of grading. We may
mention: Ishak, Batts and Ludwig, Metavir and
Histologic Activity Index (Knodell Score).
| | Author: | Aleksandr Kavokin, MD, PhD | | System: | Liver | | Subject: | Cirrhosis | | Abstract: | Liver biopsy is evaluated for fibrosis, inflammation
and necrosis (amount of dead tissue). | | Website: | www.kavokin.com | | Time: | 18:08 | | Reference: | www.rdoctor.com | | Reference 2: | |
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Articles by Aleksandr Kavokin, MD, PhD
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