Liver Biopsy (cont.)
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Alternatives to Liver Biopsy
In some instances, abdominal imaging studies can help make a diagnosis. As an example, blood tests might suggest that a patient is suffering from iron overload related to hereditary hemochromatosis. Specially-tailored MRI scans can help determine whether or not iron overload is truly present without the need for a liver biopsy.
Increasingly, non-invasive approaches are being used to assess the severity of chronic hepatitis C. Commercially available blood tests like Hepascore® and FibroSURE® assess blood levels of hyaluronic acid and other chemicals to help estimate the degree of liver inflammation and fibrosis (i.e. scarring) in patients with chronic hepatitis C.
Fibroelastography utilizes a specially-designed ultrasound unit to non-invasively assess the degree of liver fibrosis is patients with chronic hepatitis C. It remains to be determined whether fibroelastography will provide as accurate an assessment of liver fibrosis in other disease states (for example, chronic hepatitis B or alcoholic liver disease) as in chronic hepatitis C. Fibroelastography is undergoing testing in the United States and is not widely available at this time.
Liver Biopsy Techniques
The choice of a liver biopsy technique may be influenced by the disease state that is being investigated and by the patient's underlying medical condition. As an example, a stable out-patient with unexplained abnormal liver tests and no history of bleeding abnormalities might be an appropriate candidate for percutaneous liver biopsy. On the other hand, a patient with unexplained abnormal liver tests who is undergoing hemodialysis treatment for end-stage renal disease would be expected to have an abnormal tendency for bleeding after a biopsy. The risk of bleeding complications might be reduced by using a transjugular approach. Finally, the patient with unexplained abnormal liver chemistries who is undergoing elective surgery for another reason (for example, surgical treatment of obesity or cholecystectomy to treat chronic gallbladder disease) might be a candidate for liver biopsy during surgery.
Medically Reviewed by a Doctor on 10/12/2016
David C. Wolf, M.D., FACP, FACG, AGAF
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