Liver puncture is one of the most important methods to routinely diagnose liver disease, and it is generally seen as a frightening experience, but it need not be. Liver biopsy is a very mature test, and it is performed under ultrasound guidance, so that the location and depth of the puncture can be accurately located. It removes only one third of a millionth of the liver, about less than 1 mm thick and 10 mm long, for pathological examination, causing minimal liver damage.
Liver biopsy is feasible as long as the patient has normal coagulation, less severe jaundice, no hepatic hemangioma and no patients with decompensated cirrhosis. It has the characteristics of safety, wide indications, little damage, simple operation and rapid and reliable diagnosis.
At present, liver puncture biopsy is the most accurate means to understand whether there is inflammation in the liver and the severity of the lesion, and it is very important for doctors to judge the condition, and the medical profession regards this test as the gold standard for diagnosing the cause and determining the efficacy of liver disease. So, what exactly is the purpose of a liver aspiration? In what cases is liver aspiration necessary? This is probably the question that most liver disease patients are more confused about, and the following will introduce you to this knowledge, hoping to provide some help.
The value of liver puncture biopsy has the following eight points.
1, conducive to the differential diagnosis of a variety of liver diseases
Many chronic liver diseases that are difficult to diagnose clinically, such as various types of viral hepatitis, alcoholic hepatitis, hepatic tuberculosis, hepatic granuloma, schistosomiasis, liver tumors, fatty liver, liver abscess, primary biliary liver sclerosis and various metabolic liver diseases (hepatomegaly, hepatic glycogen accumulation disease, hepatic amyloidosis), etc., often require liver puncture to understand the patient’s liver lesions and provide an important It may even be a decisive basis.
2. Understanding the extent and activity of liver lesions
Liver aspiration biopsy is an examination method that can directly understand the pathological changes of liver tissue and can make a more objective and precise diagnosis. There are many patients with chronic hepatitis B who have been infected with the liver disease virus for a long time, but the abnormal transaminases found in blood tests may have been present for only six months and the level of liver disease virus content is not high. Such patients can find out by liver puncture whether the chronic liver disease is in an active stage and can deduce the severity of their lesions. For example, when the hepatitis B virus is infected, some may be HBV-DNA positive and have a major triplet, with no symptoms of their own and basically normal liver function tests. At this time, to determine whether the liver is really free of inflammation by liver function, ultrasound and other tests is impossible, then only through liver biopsy can clarify whether the liver is diseased. A comparative study between liver biopsy and liver function tests found that about 50% of patients with normal liver function who underwent liver biopsy showed varying degrees of inflammatory changes in the liver, and some even had early cirrhosis. Patients with chronic hepatitis B who were previously considered to have normal liver function were not advocated for antiviral therapy because of the poor results of antiviral therapy. If liver biopsy is not performed, it is possible that some patients should be treated but are not treated.
3.Provide etiological diagnosis of each type of viral hepatitis
Based on the fact that most hepatitis viruses are hepatophilic viruses, they tend to parasitize mostly in liver tissue. Only when the serum liver disease virus reaches a certain amount can clinical tests detect it. Therefore, there are still some viral hepatitis where clinical tests are negative for all serum hepatophilic viral markers, making it difficult to determine their etiology. However, hepatitis viruses parasitized in liver tissue can be detected by liver puncture with ultrasensitive immunohistochemistry and in situ molecular hybridization techniques.
4.Discovery of early, quiescent or still compensated cirrhosis of the liver, especially liver fibrosis
In the early stage of the disease, it is usually difficult to detect through blood tests and ultrasound examination. However, through liver aspiration examination, liver fibrosis and early, quiescent or still compensated cirrhosis can be accurately diagnosed, and the clinical type of cirrhosis can be identified, distinguishing whether it is alcoholic cirrhosis, or post-hepatitis cirrhosis, and whether it is accompanied by active hepatitis. For example, some patients diagnosed as chronic asymptomatic liver disease virus carriers can be found to be active cirrhosis or chronic active hepatitis by liver aspiration.
5.It is beneficial to the selection of drugs and the judgment of drug efficacy
Histopathological changes in liver biopsy before and after treatment are reliable indicators for judging the effect of drug therapy, providing an objective evaluation basis for clinical drug therapy. Currently, the commonly used anti-hepatitis B virus drugs include interferon, lamivudine, adefovir, telbivudine, entecavir, etc. Each drug has its own advantages and disadvantages, and if liver puncture can be performed before treatment, selective and targeted application of antiviral drugs according to the degree of inflammatory activity of liver tissue will significantly improve the efficacy.
6.Identify the nature and cause of jaundice
Clinical jaundice is often difficult to determine the cause, and liver biopsy can be performed. It can determine whether the jaundice is due to impaired bilirubin metabolism, or hepatocellular jaundice, or biliary stasis, viral or drug-induced. The prognosis and treatment are completely different for different etiologies, and only with a clear diagnosis can the correct treatment plan be formulated.
7.As an indicator of the condition and prognosis of chronic hepatitis
Liver puncture can reveal the lesions of liver tissue and provide an objective basis for the judgment of disease change and prognosis. If severe hepatitis is mainly hepatocellular edema, the condition is mild, the prognosis is good and the death rate is low; if hepatocellular necrosis is the main cause and the residual rate of normal liver cells is low, the condition is serious, the prognosis is poor and the death rate is high.
8.Diagnostic treatment can be performed
Under the guidance of B ultrasound or CT, purposeful liver puncture can be carried out for liver abscess puncture and pus drainage, injection of drugs, anhydrous alcohol intratumoral injection for liver cancer, etc. While performing puncture sampling and diagnosis, diagnostic treatment can also be carried out, so that both diagnosis and treatment can be carried out.
Therefore, for liver puncture biopsy, patients do not need to worry or be nervous at all. You may only feel slight pain during the whole operation, and if you feel nervous, please also tell your doctor, and your doctor can give you some sedative drugs, which may help. After the puncture is complete, your doctor may place you in the right lateral position and observe you for a few hours to ensure that nothing unexpected happens.
The incidence of bleeding after liver puncture is about 1 in 100,000. Since liver biopsy techniques are well established, the operation of liver puncture biopsy can be foolproof as long as the indications and contraindications are mastered and adequate preparation is done before the liver puncture. The significance of liver puncture for diagnosis suggests that the prognosis and treatment are completely different for different etiologies, so only with a clear diagnosis can a correct treatment plan be formulated for patients with liver disease, laying a good foundation for a smooth recovery.