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Liver biopsy is an
important diagnostic tool in assessing the nature and severity of liver
disease. Liver biopsy provides information concerning:
-the cause of the liver damage
-the degree of ongoing liver injury
-the extent of chronic liver damage
Liver biopsy provides the
clinician with confirmation of the diagnosis of hepatitis C, as well as
a determination of the amount of inflammation and fibrosis. In HCV
infection, there is a poor correlation between symptoms or levels of
alanine aminotransferase and histologic features of the liver. Thus,
patients with HCV infection may have normal levels of liver enzymes and
have significant fibrosis on biopsy. Conversely, patients may also have
elevated serum ALT and trivial liver disease.(1)
Risks
Liver biopsy carries a
small risk of complications. If performed correctly, most patients do
not feel pain during the biopsy. Some of the risks include the
following:
-Bleeding requiring
transfusion in less than one per thousand biopsies
-surgery in less than per thousand biopsies
-Penetration of other organs such as lung, kidney, gallbladder,
intestine
-Fatality in less than one per ten thousand biopsies
Because of the small risk
of complications, liver biopsy should only be performed when the
information will be useful for optimal patient care and only after
written informed consent has been obtained. In hepatitis C, this would
include prior to starting HCV treatment and determination of the extent
of liver damage, particularly in patients with persistent, significant
elevations in ALT
References:
http://hepatitis.va.gov/vahep?page=tp03-01-02-01
Bravo AA, Sheth SG, Chopra S. Current Concepts: Liver Biopsy. N Engl J
Medicine 2001; 344(7):495-500.
Ibid., 498 (table 2).
Batts KP, Ludwig J. Chronic hepatitis. An update on terminology and
reporting. Am J Surg Pathol 1995;19(12): 1409-17.
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