Liver biopsy

The biopsy of a liver is carried out for definition of a condition of the body which is in process of an inflammation. The procedure is that by a special needle do a puncture of skin, hypodermic fabrics and a liver, take material for a research – a small piece of body (биоптат) about 2 cm long and with a diameter of 1 mm. The received fragment of a liver is transferred to glass and studied under a microscope. Sometimes for diagnosis it is required биоптат the bigger size for what carry out a wedge-shaped biopsy – excise the wedge-shaped site of a liver.

The puncture biopsy of a liver is painful, can cause complications therefore it is not recommended to carry out it often. For this reason there is a selective approach to the diagnostic procedure. Some medical institutions carry out a biopsy to one and all patients infected with hepatitis C, and to some – only by that in whom the virus of a genotype 1 is found: these patients only in 50% of cases successfully recover interferonam (in difference of those who are infected with a virus of genotypes 2 and 3) therefore it is necessary to keep a condition of a liver under control and to timely adjust the therapeutic scheme.

Purpose of a puncture biopsy of a liver to those patients for whom the started disease form since the procedure is traumatic is diagnosed is not considered expedient and can worsen a condition of the patient. Diagnosis and purpose of treatment in this case is carried out by results of biochemical, general blood test, the analysis of a leukocytic formula.

Also there is no need for carrying out a biopsy of a liver after treatment of hepatitis C.

As carry out a puncture biopsy of a liver

Before the procedure the doctor is obliged to inform the patient on how there will pass the biopsy of a liver and what complications can arise in detail. For exact designation of the site for a puncture in certain cases appoint preliminary ultrasonography.

The liver biopsy passes as follows:

• the patient lays down on a back, stuffs up the right hand for the head. During a fence of a bioptat it needs to keep an immovability.
• For ensuring psychological comfort can give to the patient weak sedative.
• The place of a puncture before the procedure is disinfected, anesthetized then do a small cut and enter through it a needle for a biopsy, take away a small fragment of tissue of liver.

After a biopsy of a liver of the patient four more hours have to observe since he can feel discomfort and pain, and anesthetic can be necessary for him. On an extent as eight hours after holding a procedure the patient is not recommended to take the wheel, to be returned to the activity connected with control of difficult mechanisms. Days after a biopsy the patient cannot play sports. For a week after a biopsy of a liver it is impossible to take aspirin and drugs containing acetylsalicylic acid, means against an inflammation: Motrinum, advit, an ibuprofen, Naprosinum, Indocinum.

The complications arising after a biopsy

In spite of the fact that the biopsy of a liver is regarded as small surgical intervention, the probability of development of complications is small – only 1%: during the procedure the accidental puncture of a gall bladder, lungs, a kidney or intestines can be made, the infection can get into an abdominal cavity. Also there are cases of discovery of bleeding from a liver. For treatment perform operation or hemotransfusion. Probability of a lethal outcome after a liver biopsy – 0,1% (one case per thousand).

If in three days after the procedure the increased temperature is observed, nausea, a fever, weakness, trouble breathing, an acute pain in a breast, a liver, a shoulder, a peritoneum will develop, it is necessary to ask for medical care.

Types of a biopsy

Except a puncture biopsy of a liver in certain cases it is possible to carry out a laparoscopic or transvenous biopsy.

At a laparoscopic biopsy in an abdominal cavity do a section, through it enter a tube with the camera and the doctor, looking at the image which is transferred to the monitor, takes necessary fragments of a liver. Laparoscopic diagnosis is applied when want to study a specific fragment from a certain site of body.

The transvenous biopsy of a liver is carried out when in an abdominal cavity there is a liquid or at the patient blood is badly turned: on a neck enter a catheter with a needle into a vein, advance it on veins to a liver and carry out a material intake.

Results of a biopsy of a liver

For assessment of results of a biopsy there are several ways. The most widespread:

• method Metavir. It is developed for interpretation of results of a biopsy of patients with hepatitis C. During the analysis establish degree and a stage of an inflammation. Depending on degree balls – 0-4 are specified: "0" - there is no inflammation, and balls "3" and "4" – an inflammation heavy. The stage of an inflammation gives the chance to draw a conclusion on scarring and amount of fibrous fabric in a liver. Fibrosis stages are also estimated on a scale 0-4: "0" - there are no hems; "1" - scarring minimum; "2" - scarring is also it went beyond body; "3" - the extending bridge-like fibrosis (the sites affected with fibrosis connect among themselves); "4" - deep scarring or cirrhosis.
• Method Knodel. By results of a biopsy four separate balls which are united in a uniform index are appropriated. The first component of an indicator indicates a bridge-like and periportal necrosis, it is measured on a scale 0-10. Two more components of an index displaying a portal inflammation and a necrosis of hepatic lobes change within 0-4. The combination of these indicators displays liver inflammation degree: "0" – there is no inflammation; "1-4" - the inflammation is minimum; "5-8" - an inflammation small; "9-12" - the inflammation is moderate; "13-18" - the inflammation is considerable. The fourth last component displays extent of scarring of body within 0-4 (there are no "0" hems – "4" cirrhosis and extensive scarring).