Cirrhosis liver biopsy

Ultrasound examination is used routinely to evaluate cirrhosis a small, nodular liver with increased echogenicity is consistent with cirrhosis. Liver biopsy is the only way to diagnose cirrhosis definitively, but it is often deferred in lieu of a... 

General outcomes for treating hepatitis are to (1) prevent the spread of the disease (2) prevent and treat symptoms (3) suppress viral replication (4) normalize hepatic aminotransferases (5) improve histology on liver biopsy and (6) decrease morbidity and mortality by preventing cirrhosis, hepatocellular carcinoma, and ESLD. 

Toxicities are GI (stomatitis, diarrhea, nausea, vomiting), hematologic (thrombocytopenia, leukopenia), pulmonary (fibrosis, pneumonitis), and hepatic (elevated enzymes, rare cirrhosis). Concomitant folic acid may reduce some adverse effects without loss of efficacy. Liver injury tests (aspartate aminotransferase or alanine aminotransferase) should be monitored periodically, but a liver biopsy is recommended during therapy only in patients with persistently elevated hepatic enzymes. MTX is teratogenic, and patients should use contraception and discontinue the drug if conception is planned. 

Liver biopsies for pathologic classification as chronic persistent hepatitis, chronic active hepatitis, or cirrhosis. 

Hepatic function impairment Administration of valacyclovir to patients with moderate (biopsy-proven cirrhosis) or severe (with and without ascites and biopsy-proven cirrhosis) liver disease indicated that the rate but not the extent of conversion of valacyclovir to acyclovir was reduced, and the acyclovir half-life was not affected. Dosage modification is not recommended for patients with cirrhosis. 

Liver Methotrexate causes hepatotoxicity, fibrosis, and cirrhosis, but generally only after prolonged use. Acutely, liver enzyme elevations are frequent, usually transient and asymptomatic, and also do not appear predictive of subsequent hepatic disease. Liver biopsy after sustained use often shows histologic changes, and fibrosis and cirrhosis have occurred these latter lesions often are not preceded by symptoms or abnormal liver function tests (see Precautions). For this reason, periodic liver biopsies are usually recommended for psoriatic patients who are under long-term treatment. Persistent abnormalities in liver function tests may precede appearance of fibrosis or cirrhosis in the RA population. 

Psoriasis The usual recommendation is to obtain a liver biopsy at 1) pretherapy or shortly after initiation of therapy (2 to 4 months), 2) a total cumulative dose of 1.5 g, and 3) after each additional 1 to 1.5 g. Moderate fibrosis or any cirrhosis normally leads to discontinuation of the drug mild fibrosis normally suggests a repeat biopsy in 6 months. 

Nausea and mucosal ulcers are the most common toxicities. Progressive dose-related hepatotoxicity in the form of enzyme elevation occurs frequently, but cirrhosis is rare (< 1%). Liver toxicity is not related to serum methotrexate concentrations, and liver biopsy follow-up is only recommended every 5 years. A rare hypersensitivity-like lung reaction with acute shortness of breath is documented, as are pseudolymphomatous reactions. The incidence of gastrointestinal and liver function test abnormalities can be reduced by the use of leucovorin 24 hours after each weekly dose or by the use of daily folic acid, although this may decrease the efficacy of the methotrexate. This drug is contraindicated in pregnancy. 

Treatment of patients with chronic HCV infection is recommended for those with an increased risk for progression to cirrhosis. The parameters for selection are complex. In those who are to be treated, however, the current standard of treatment is once-weekly pegylated interferon alfa in combination with daily oral ribavirin. Pegylated interferon alfa-2a and -2b have replaced their unmodified interferon alfo counterparts because of superior efficacy in combination with ribavirin, regardless of genotype. It is also clear that combination therapy with oral ribavirin is more effective than monotherapy with either interferon or ribavirin alone. Therefore, monotherapy with pegylated interferon alfa is recommended only in patients who cannot tolerate ribavirin. Factors associated with a favorable response to therapy include HCV genotype 2 or 3, absence of cirrhosis on liver biopsy, and low pretreatment HCV RNA levels. 

Percutaneous liver biopsy after each 1.5 g of total accumulated methotrexate dosage to detect hepatic fibrosis or cirrhosis not reliably predicted by serum aminotransferase tests are recommended (1,50). Concurrent use of NSAIDs may increase toxicity of methotrexate, although toxicity may be avoided if the drugs are separated by 12 h. 

Liver biopsy confirmed the presence of cirrhosis there... 

Diagnosis of alcoholic cirrhosis of the liver was made based on Mrs MW s clinical features, liver function tests, abdominal ultrasound, CT scan and liver biopsy. 

A biopsy is often required to make a diagnosis of most types of liver disease. A specimen of liver can be used to identify fibrosis, cirrhosis, cholestasis and hepatitis, both acute and chronic, and tumours. Biochemical measurements can also be taken from a biopsy specimen to determine iron and copper content, virology, microbiology and haematology (e.g. increased numbers of eosinophils in a drug-induced cause). The biopsy can give an indication of the extent of the liver damage. See Chapter 3 for slides of liver biopsies. 

The activity of acetyltransferase as measured by the rate of acetylation of p-aminobenzoic acid was significantly reduced in liver biopsy samples from subjects with cirrhosis compared to controls [79]. 

Liver biopsy - established cryptogenic cirrhosis (inactive). No cholestasis... 

Hepatic fibrosis or cirrhosis may be caused by therapeutic use of methotrexate, e.g. for psoriasis in the latter case the risk is lessened by giving a large dose weekly rather than a smaller dose daily and by monitoring progress by liver biopsy after every 1.5-2 g of methotrexate. Chronic exposure to amiodarone may lead to cirrhosis this drug can also cause an alcoholic hepatitis-like picture. 

Treatment should last 6-12 months but should cease after 3 months if any virus RNA persists. Depression, agitation, headache and malaise may limit treatment. Its use is currently restricted to patients with severe necroinflammatory changes on liver biopsy (who are thought to be most at risk of progressing to cirrhosis). 

Arterial bruit A systolic rushing sound synchronized with the heart beat indicates increased arterial blood flow. This often barely audible sound is easier to discern if one listens for arterial bruit and feels the patient s pulse at the same time. It is sometimes heard where aneurysm or stenosis is present in large arteries (e.g. coeliac artery, hepatic artery) as well as in arteriovenous malformations, highly vascularized liver tumours, pronounced acute alcohol hepatitis, 1-2 days after liver biopsy resulting from temporary arteriovenous fistula, or in twisted arteries in cirrhosis. It is seldom found in healthy persons. (10, 13, 44)... 

Colombo, M., del Ninno, E., de Franchis, R., de Fazio, C., Festorazzi, S., Ronchi, G., Tommasini, M.A. Ultrasound- assisted percutaneous liver biopsy superiority of the true-cut over the Menghini needle for diagnosis of cirrhosis. Gastroenterology 1988 95 487-489... 

Ricketts, W.E., Kirsner, J.B., Palmer, W.L., Sterling, K. Observations on the diagnostic value of liver biopsy, tests of hepatic function, and electrophoretic fractionation of serum proteins in asymptomatic portal cirrhosis. J. Lab. Clin. Med. 1950 35 403-407... 

Orlando, R., Lirnssi, F., Okolicsanyi, L. Laparoscopy and liver biopsy further evidence that the two procedures improve the diagnosis of liver cirrhosis. A retrospective study of 1003 consecutive examinations. J. Chn. Gastroenterol. 1990 12 47—52... 

Zachariae, H., Kragballe, K., Sogaard, H. Methotrexate induced cirrhosis studies including serial liver biopsies during continued treatment. Brit. J. Dermatol. 1980 102 407 —412... 

Desmet, V.J., Sdot, R., van Eyken, R Differential diagnosis and prognosis of cirrhosis role of liver biopsy. Acta Gastroenterol. Belg. 1990 53 198-208... 

A 49-year-old man with alcoholic cirrhosis developed jaundice, fatigue, and choluria after he started to take celecoxib 200 mg/day for musculoskeletal pain (9). There were increases in transaminases, alkaline phosphatase, and bilirubin (to 547 pmol/l). Liver biopsy showed cirrhosis and marked hepatocellular cholestasis. On withdrawal of celecoxib the bilirubin began to fall very slowly 1 year later he was well, with a total bilirubin concentration of 44 pmol/l. 

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