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It is to take a piece of tissue that makes up the liver to check if any alterations at the cellular level.
Liver biopsyThe liver is one of the largest human body organs. It is located in the abdomen, connected to the digestive tract, and performs many functions. Among the most important functions are the secretion of bile, cleansing of toxins, and the synthesis of clotting factors. Liver biopsy involves taking a piece of the fabric that makes up this body for study under a microscope and see if there are any alterations at the cellular level.
It is a test that is performed frequently for the study of alterations of liver cirrhosis, hepatomegaly or hepatocellular carcinoma. Used from 1939 thanks to Drs. Ilvesen and Copenhagen Roholm; Since then has been to diagnose diseases that were not well classified at the beginning of the 20th century.
It is an invasive technique, but little aggressive, and is done quickly without the need for a hospital admission. It takes less than half an hour and allows to know the patient's disease deeply to provide you with the most appropriate treatment.
Their risks are similar to those of other types of biopsy; It is a test that causes some pain, although less that years ago thanks to current techniques, that have managed to reduce it, both in intensity and in duration (only lasts a few seconds). Although it seems that the liver has easy access is not easy to reach, since the abdominal wall is made up of several layers of muscles and ribs are also an impediment. In addition, it is the risk of puncturing a lung or tear the liver, that today this test is performed under ultrasound control.
When a liver biopsy is doneLiver biopsy He is performed when changes that suggest liver impairment in a person are. In recent years the liver biopsies have been reduced considerably thanks to the development of imaging such as ultrasound, magnetic resonance imaging or computed tomography techniques. The use of fibroscan, a novel technique that allows to know the density of the liver and which is already used on a routine basis was also implemented.
Disorders that may require the completion of a liver biopsy are:
Cirrhosis: when the liver is damaged inside appear fibrous scars that invade the body destroying its structure and limiting its operation. Cirrhosis has many causes, the most common are alcohol, viral hepatitis and other genetic diseases.
Autoimmune hepatitis: sometimes our body's defenses attack the liver. Lymphocytes and other white cells invade the spaces of the liver and destroy it. A biopsy allows you to visualize these changes.
Sclerosing cholangitis and biliary cirrhosis: these two diseases have an uncertain origin, probably the immune system is involved in some way. Biopsy helps to identify changes in the bile ducts.
Infections: some infections affect in particular the liver. Although no case of a biopsy, drainage of abscesses (bacterial or amoebic) is performed similarly to this technique.
Fatty liver: it is the accumulation of fat in the liver, so that the cells swell and prevent proper operation. It usually occurs in the context of alcohol consumption, but familial cases in people who do not take excessive amounts of alcohol are also given.
Lymphoma: Although lymphoma is a cancer of white blood cells of the immune system, many times is organized into specific organs such as the liver. Biopsy may remove doubts, since imaging techniques are often not conclusive.
Hepatocellular carcinoma: is the malignant tumor of the liver which has more importance in this body. Biopsy allows you to diagnose it safely and studying your degree of malignancy. Certain imaging techniques allow to avoid biopsy sometimes.
Preparation for liver biopsyIf you are performing a liver biopsy , these are the issues that you must take into account:
Duration: the test will last a total of 15 to 20 minutes. The biopsy itself will be one minute, the rest consists of the preparation of the material and the biopsy area.
Income: liver biopsy can be performed on a query or a room of cures, in such a way that it does not require hospital admission.
Is necessary to be accompanied?: is recommended, as there are sensitive people who are sore or somewhat dizzy after the test.
Drugs: don't need to take any prior medication. You should tell your doctor all the medicines taken regularly and will decide if we will suspend any. It is important to also inform of allergies to medications or other products, if you have them. Consult your doctor before taking aspirin, ibuprofen, or other NSAIDs, a week before the test. Paracetamol is not contraindicated for this evidence.
Food: is necessary to remain in fasting 8 hours before the test, not even drinking water. Throughout the day, it is recommended to take a light meal and avoid taking all day coffee, alcohol and other exciting substances, including also the day prior to the test.
Clothes: you can go to the test with the same clothes every day. When you get to the hospital or doctor's office they will give you a gown to change you.
Documents: is essential to bring with you the steering wheel which shows the performance of this test. The health insurance card is recommended. Normally you will not you any document after the test because it takes time to analyze the results. Before the test, they will make you sign an informed consent.
Pregnancy and breast-feeding: liver biopsy is not contraindicated in pregnancy or lactation, but that State should know because some biological constants that are studied will be altered from itself during these stages.
Contraindications: do not have any specific contraindication.
How the liver biopsyFirst your doctor will assess in a consultation if necessary or not to perform a liver biopsy. If he deems it necessary he will inform you of the why, how is performed, what information can bring, and what are the possible risks. It will give you an informed consent document outlining the main features of the test, you will have to sign if you agree to its realization.
Biopsy may make you it the same day or in another different appointment. When going to ask you in the first place that you change your clothes and views a comfortable gown for you and for the doctor that perform you the test. Then will measure you all vital signs such as blood pressure, heart rate, respiratory rate and temperature, to check that you are in optimal conditions to put you to the test. You must inform the doctor all medications you are taking and if you have a problem with blood clotting.
Sometimes they placed you a via vein in the arm if it had introduced any medications during the conduct of the test, although it is not common. Sometimes they will offer you some relaxing drug to make you stay sedated during the test; It is recommended if you are nervous or if you're particularly sensitive to pain. Prepared once you will be asked you to tumbes on a stretcher in a position that facilitates the realization of the test. You may lie down face up and place your right hand below the neck, so you let all the right side exposed.
To proceed with the biopsy, the first thing that will will be clean the skin in the area where it is done with some antiseptic. Then they injected an Anaesthetic from the surface of the skin to deeper levels. You will feel a slight prick of the needle, and then a burning sensation at the very moment in which the anesthesiagets. This area of the body is asleep and insensitive and they may make a small incision with a scalpel, to separate the skin and expose the muscle. They will put a gel near the incision for a ultrasound that locate the liver and serve as a guide to needle done you at the same time.
Through the incision they inserted the needle, fine and long, reaching the liver; at that time, you will notice a very strong pressure on the side that can reach the right shoulder. The needle will catch a small cylinder of tissue and they will draw it at once. During this prick will give you instructions to keep an adequate rate of breathing that will help you to concentrate and to endure the hassle.
It is normal that the puncture point blood a little; Why apply pressure continued with firmness for a few minutes to stop the bleeding. Then they placed a bandage or a compression dressing and you'll be ready to go home. It will not need to wait on the results, since they need to be processed for a time, and at first glance not seen any alteration. The dressing will keep for at least two days; It is normal that the days after the test have pain in the area and need to take some pain reliever you your doctor will prescribe.
Complications of liver biopsyAll biopsies have risks to be evidence that invade the body organs, albeit slightly. They tend to be infrequent complications and in the majority of cases have easy solutions. They can appear during or after the test, and if they are serious you should go to the emergency room. Some of the most common complications in a liver biopsy are:
Bleeding from the point of biopsy or internal bleeding.
Local infection with fever.
Reaction to anesthesia or sedation during the test.
Drilling of other organs such as the gallbladder, kidney or lungs.
Liver biopsy resultsThe liver biopsy results may take from one week up to a month. The waiting time, it therefore tends to be long and requires patience and tranquility. The reason is that the sample biopsied can not be analyzed at the time, it has to be processed in a laboratory. The following analysis will be carried out on this sample:
Histological staining: using special dyes cells are colored and can be observed under the microscope directly. The basic stain is hematoxylin and eosin (purple and pink).
Staining metals: iron, copper and other deposits can be detected thanks to her.
Immunofluorescence studies: you can attach fluorescent substances to antibodies that bind to specific components of the cells and thus to detect its presence.
Microbiological cultures: If infection is suspected sample can be grown in appropriate media that allow the growth of microorganisms.
Molecular studies: specific proteins that classified the types of cells that contain the sample can be identified.
All of these tests will be performed by the physician. Along with the symptoms, analytical studies and biopsy, can be a diagnosis most of the times. So you can explain what happens to you, and what are the treatments available to solve your disease.