Liver biopsy is performed to determine the state of the body in the process of inflammation. The procedure is that doing special needle puncture of the skin, subcutaneous tissues and liver biopsy specimens produced for study - a small piece of organ (biopsy) and a length of about 2 cm in diameter of 1 mm. The resulting fragment was transferred onto a glass liver and examined under a microscope. Sometimes the diagnosis requires a biopsy larger, which carried a wedge biopsy - a wedge-shaped portion of the liver was excised.
Needle biopsy of the liver is painful, can cause complications, so it is often carried out is not recommended. For this reason, there is a selective approach to the diagnostic procedure. Some medical institutions conduct the biopsy, without exception, patients infected with hepatitis C, and some - only those who have discovered the virus genotype 1: these patients only 50% of cases are successfully cured interferons (as opposed to those who are infected with the virus genotypes 2 and 3), therefore it is necessary to control the condition of the liver and timely adjustments to the therapeutic scheme.
It is not considered appropriate to the appointment of liver biopsy for patients diagnosed with advanced forms of the disease, as traumatic procedure and may worsen the patient's condition. Diagnosis and treatment assignment in this case, based on the results of biochemical, general blood analysis, analysis of leukocyte formula.
There is also no need for a liver biopsy after the treatment of hepatitis C.
How to spend a puncture biopsy of the liver
Before the procedure, the doctor must inform the patient in detail about how to pass a liver biopsy and what complications can arise. For the exact designation of land for punctures in some cases, prescribe the preliminary ultrasound.
It takes a liver biopsy as follows:
- the patient lies on his back, lays his head right. During biopsy sampling it is necessary to keep still.
- To provide psychological comfort to the patient can give a weak sedative.
- The puncture site is disinfected before the procedure, pain relievers, and then make a small incision and injected through a needle biopsy, take a small piece of liver tissue.
After the biopsy, the patient's liver for another four hours have to watch, because he may experience discomfort and pain, and he may need pain medication. For at eight hours after the procedure the patient is not recommended to get behind the wheel to return to the activities related to the management of complex mechanisms. Twenty-four hours after the biopsy the patient can not play sports. For weeks after the liver biopsy should not take aspirin or aspirin-containing products, anti-inflammation: Motrin, Advil, Ibuprofen, Naprosyn, Indocin.
Complications arising after biopsy
Despite the fact that liver biopsy is seen as a small surgical procedure, the likelihood of complications is low - only 1%: during the procedure may be made random puncture gall bladder, lung, kidney or intestine, the abdominal cavity may become infected. There is also a case of opening the bleeding from the liver. For the treatment carried out an operation or a blood transfusion. The probability of death after liver biopsy - 0, 1% (one case per thousand).
If three days after the procedure there will be a fever, nausea, chills, weakness, trouble breathing, severe chest pain, liver, shoulder, peritoneum, should seek medical advice.
Types of biopsy
In addition to liver biopsy in some cases can be performed laparoscopic biopsy or transvenous.
When laparoscopic biopsy of abdominal incision, administered through a tube with a camera and doctor looking at the image is transmitted to the monitor, take the necessary pieces of liver. Laparoscopic diagnosis is used in cases when they want to study a particular fragment of a certain area of the body.
Transvenous liver biopsy is performed when the abdominal cavity is a liquid or a patient collapses bad blood to a vein in the neck catheter with a needle, pushing it through the veins to the liver and carried fence material.
The results of a liver biopsy
To evaluate biopsies there are several ways. The most common:
- Metavir method. Designed for interpreting the results of biopsies of patients with hepatitis C. The analysis set the degree of inflammation and stage. Depending on the degree of specified balls - 0-4: "0" - no inflammation, and balls "3" and "4" - severe inflammation. Step inflammation allows to conclude scarring and amount of fibrous tissue in the liver. The stages of fibrosis are also evaluated on a 0-4 scale: "0" - no scars; "1" - minimal scarring; "2" - scarring and it has gone beyond the body; "3" - spreads bridging fibrosis (areas affected by fibrosis, connected to each other); "4" - deep scarring or cirrhosis.
- Knodell method. According to the results of the biopsy are assigned four separate ball, which are combined into a single index. The first component of the index indicates the bridge and periportal necrosis, it is measured on a scale of 0-10. Two component index displaying portal inflammation and necrosis of the liver lobes vary within 0-4. The combination of these indicators shows the degree of inflammation of the liver, "0" -no inflammation; "1-4" - an inflammation of the minimum; "5-8" - an inflammation of the small; "9-12" - moderate inflammation; "13-18" - an inflammation significantly. Fourth last component indicates the degree of scarring body within 0-4 ("0" no scars - "4" cirrhosis and extensive scarring).