Medicine of the Future in America

Category Archives: Liver disease - Part 2

The role of liver biopsy in the management of patients with liver disease: Alcoholic liver disease (Part 2)

Serum biochemistry and the currently available imaging modalities have severe limitations in determining the relative contributions of fatty liver, alcoholic hepatitis and cirrhosis to the patient’s disease. Histological examination is, therefore, of value in determining the prognosis for these patients. The characteristic features of alcoholic hepatitis include polymorphonuclear infiltrates, centrilobular hepatocyte swelling and degeneration, macrovesicular and microvesicular steatosis, Mallory bodies, and pericentral-perisinusoidal fibrosis (Figure 1). In 50% to 93% of cases, alcoholic hepatitis is superimposed on fully developed cirrhosis and is associated with a significantly worse prognosis. Continue reading

The role of liver biopsy in the management of patients with liver disease: Alcoholic liver disease (Part 1)

Thus, it appears that the role of liver biopsy in the management of patients with liver disease remains controversial. The following is a summary of the published literature.

There is a prevailing belief that alcoholic liver disease can be diagnosed with an acceptable degree of accuracy based on clinical findings together with biochemical tests . However, solid evidence to support this statement is lacking. In one study, only 39% of physicians caring for patients with heavy alcohol intake used liver biopsy to make the diagnosis of alcoholic liver disease. In another prospective study, 347 men who chronically consumed more than 50 g of alcohol underwent liver biopsies irrespective of clinical or biochemical findings. Continue reading

The role of liver biopsy in the management of patients with liver disease: CONTROVERSIES REGARDING LIVER BIOPSY

virological, immunological and molecular genetic testingIn another retrospective study of 365 patients at university hepatology clinics, Spycher and colleagues found that liver biopsy yielded an additional diagnosis in at least 10% of patients, and led to a change in diagnosis in 6.8%. Overall, liver biopsy led to a change in the management of 12.1% of subjects. The authors therefore advised that, notwithstanding the presence of advanced virological, immunological and molecular genetic testing, there is an important role for liver biopsy.

In a prospective study involving 36 patients, Sorbi and colleagues confirmed that liver biopsy changed the diagnosis in 14% of cases, and affected the frequency of liver test monitoring in 36%. Treatment recommendations were altered in 12 of 36 cases, 10 of whom were offered investigational therapies. The authors, however, cautioned that the risks and benefits of a liver biopsy should be carefully weighed, especially in settings in which neither proven treatments nor investigational therapies are available. Continue reading

The role of liver biopsy in the management of patients with liver disease: INDICATIONS FOR LIVER BIOPSY

Liver biopsies are performed for diagnostic and prognostic reasons. Histopathological examination is the best method for making the diagnosis when noninvasive tests are inconclusive. In cases in which the diagnosis has already been established by other means, it may reveal additional diagnoses as well as information on disease severity. For example, although laboratory and imaging tests may suggest the presence of cirrhosis, liver biopsy remains the definitive procedure for this purpose. Moreover, it can help stage the disease and estimate its prognosis. Serial biopsies can document the progression of chronic conditions such as hepatitis C (HCV). Continue reading

The role of liver biopsy in the management of patients with liver disease

liver biopsyAlthough there are many causes of liver disease (Table 1), recent advances in diagnostic techniques have led many physicians to question the need for liver biopsy. For example, alcoholic liver disease can often be diagnosed with a reliable history from the patient and family members, as well as clinical and biochemical evidence of chronic alcohol consumption. Viral and autoimmune hepatitis can be diagnosed serologically, while metabolic diseases can often be identified using genetic testing (Table 2). On the other hand, nonalcoholic steatohepatitis, a common cause of chronically abnormal liver enzymes, cannot be accurately diagnosed either clinically or radiologically . Therefore, many clinicians are now reconsidering the need for liver biopsy in patients with chronic liver enzyme abnormalities, and there is considerable disagreement among hepatologists on this issue. Continue reading

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