LIVER BIOPSY - THE FACTS  

Source:  Hepatitis C Foundation Handout
 
  Abnormal liver function tests do suggest chronic disease, but there is no
correlation between liver function tests and the severity of the disease.  A
liver biopsy is the BEST way to tell what damage has been done to your liver
because of the hepatitis virus.  Liver damage can occur in symptomatic as well
as asymptomatic patients.  Damaged liver cells will impair the function of the
liver.
 
    THE BIOPSY
 
      A liver biopsy is a diagnostic procedure that is used to obtain a small
amount of liver tissue.  It will then be examined under a microscope by a
pathologist to determine if any liver damage has occurred.  The liver biopsy
will indicate if the liver is scarred (scar tissue is beginning to replace
functioning liver cells), if inflammation (cellular infiltration and swelling)
is present, or if necrosis (dead liver cells) are present.  When the liver
becomes permanently injured the condition is called cirrhosis.

How is it performed?  
      A liver biopsy is performed by a specialist at the hospital.  Some hospitals keep you overnight  while others keep you for up to eight hours.  It all depends on where you are having yours done.  Both ways are acceptable.  Your physician will determine the best location on your liver for
this tissue to be taken.  You will lie down on your side with your right hand
under your head.  You will be told to remain as still as possible during the
procedure.  The location will be cleaned with an antiseptic.  The physician
will insert a needle full of anesthetic to numb the area.  You may feel mild
pain as a result of the anesthetic.  When the area is completely numb the the
specialist will insert the biopsy needle into your liver, taking a piece.  You
may experience some pain when the needle is inserted.  You will be told to hold
your breathe while the needle is in your body.  The needle is then taken out
after about one second.  You will be told to breathe normally.  A bandage will
be placed over the biopsy site.  Your vital signs will be closely monitored
while in the hospital.  You will remain on your right side for several hours to
help stop bleeding.  You may experience pain for several hours following this
procedure.  Ask for pain medication if needed.  You should rest for the next 24 hours.

Possible complications:

      Possible complications from the biopsy include tenderness, rigidity and bleeding a the biopsy site.  Be alert for  symptoms of a collapsed lung, such as labored breathing or persistent shoulder or chest
pain.  You should notify your doctor immediately if you are experiencing any of the above.

Risks: 

        There are minimal risks involved when having a biopsy.  The
primary risk involved is bleeding from the biopsy site.  This only occurs in 1%
of patients.  Other risks may include puncturing of other internal organs.
This rarely occurs.  The risk of death from a liver biopsy is less than .1%.
 
  A BIOPSY SHOULD NOT BE DONE IF YOU HAVE TAKEN ASPIRIN
  PRODUCT 5-7 DAYS PRIOR TO PROCEDURE.
 
  A BIOPSY SHOULD NOT BE DONE IF YOUR HEMOGLOBIN IS BELOW  9-10 GRAMS/dl.
 
  A BIOPSY SHOULD NOT BE DONE IF YOUR PROTHROMBIN TIME
  INR IS ABOVE 1.4.
 
  A BIOPSY SHOULD NOT BE DONE ON PATIENTS WITH BLEEDING DISORDERS UNLESS THEY
ARE TRANSFUSE WITH CLOTTING FACTOR PRIOR TO THE BIOPSY.
  ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
  Source:  Teaching Patients With Chronic Conditions
                  Springhouse Corp, Springhouse, Penn, 1992
 
  PREPARING FOR A LIVER BIOPSY
  Patient-Teaching Aid
 
  BEFORE THE TEST:
  * Don't eat or drink anything 4 to 8 hours before the test, or as your
     doctor orders.
  * Expect to have a blood test to measure your blood's clotting ability and
    other factors.
  * Just before the test, be sure to empty your bladder.
 
  THE PROCEDURE
  * During the test, you will lie on your back with your right hand under
    your head.  You will need to remain in this position and keep as still
    as you can.  The doctor will drape and cleanse the area on your
    abdomen.  He will then inject a local anesthetic, which may sting and
    and cause brief discomfort.
  * When you are told, hold your breath and lie still as possible as the
    doctor inserts the biopsy needle into the liver.  Be assured that the
    needle will remain in your liver for only about 1 second.  The needle may
    cause a sensation of pressure and some discomfort in your right upper
    back.
  * After the needle is withdrawn, resume normal breathing.  The doctor
    will apply pressure to the biopsy site to stop any bleeding.  Then he will
    apply a pressure bandage.
 
  AFTER THE TEST
  * You will be told to lie on your right side for 2 hours, with a small pillow
    tucked under your side.  For the next 24 hours, you should rest in bed.
    Your vital signs will be checked periodically.
  * Tell your doctor or nurse right away if you experience any problems,
     including chest pain, persistent shoulder pain, or difficulty breathing.
  * You can resume your normal diet.
  ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
 
 Information gathered from past biopsys have reported that some doctors will
perform a liver biopsy without the use of anesthetic, while others use it.
Some doctors will use a scoping devise/Ultrasound to help guide the biopsy
needle.  Some biopsy patients report no pain, some with mild pain or pressure,
and others experience much discomfort during and after. 
 
 ALL BIOPSYS ARE NOT THE SAME!
 (Even different biopsys done on the same patient!)
 
 Best advise is to discuss the biopsy procedure with your doctor  BEFORE the
procedure.  Ask about the different options offered.  Bring in a list of
questions for your doctor-or just copy this paper, and bring it in to help you
discuss your biopsy.
 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
 INTERPRETING BIOPSY RESULTS
 
 Book Source:  "Living With Hepatitis C"-A Survivor's Guide
                        Dr. Gregory T. Everson, MD & Hedy Weinberg
                        Hatherleigh Press, New York, 1998
 
 *STAGE I- is characterized by inflammation without the development of any scar
tissue.
 *STATE II- features include inflammation with early scarring (fibrosis) in one
zone
 (portal) of the liver.
 *STATE III- shows bridging the fibrosis between adjacent portal tracts.
 *STATE IV- is cirrhosis (advanced scarring with loss of normal liver
architecture.
 
 Later Warning Signs of Cirrhosis
 What does cirrhosis mean?  Cirrhosis simply means the hardening of the liver
due to a buildup of scar tissue.  Patients who have early-stage cirrhosis may
not have any symptoms.  Late stage cirrhosis is characterized by complications
(some of which are life threatening) and limited survival.  Patients with any
or all of the following signs may be potential candidates for a liver
transplant:
 
 * Yellowing of the skin and whites of the eyes: jaundice.
 * Fluid buildup: ascites.
 * Bleeding: variceal hemorrhage.
 * Mental confusion: portal-systemic encephalopathy.
 * Weight loss.
 * Thinning of bones (osteoporosis) and fractures: metabolic bone diseases.
 * Blood clotting problems: coagulopathy.
 * Itching: pruritus.