Liver biopsy involves removal of a small piece of tissue from the liver to evaluate for damage or disease. This diagnostic test is usually suggested when blood tests reveal high levels of liver enzymes or excessive iron. An inflamed liver may also need to be examined with a liver biopsy. Cases of cirrhosis or hepatitis may require liver biopsy to diagnose the extent of liver damage. A patient scheduled for liver biopsy will need to keep the physician informed of various medications that are taken, such as anticoagulants, ibuprofen and aspirin. It is necessary to fast for about 8 hours prior to the liver biopsy procedure. The patient may be asked to stay in the hospital for a few hours to observe for any signs of bleeding or other complications as as peritonitis or puncture of the gallbladder.Liver biopsy is done in the following ways:
Percutaneous liver biopsy involves use of special needle to make an incision through the skin, taking care not to nick any other internal organs.
Laparoscopic liver biopsy involves use of laparoscope to make a small incision in the abdomen. This aids the physician in taking a biopsy from a specific part of the liver.
Transvenous liver biopsy involves insertion of a catheter into a vein in the neck and guiding it to the liver. The biopsy needle is fitted to the catheter.
A syndrome that is characterized by acute metabolic condition that can occur during prolonged alcohol abuse. It was described initially in 1958 by Dr Leslie Zieve for patients with a combination of alcoholic liver disease Hemolytic Anemia and Hypertriglyceridemia. Zieve's syndrome exhibits liver and blood abnormalities caused by heavy alcohol consumption.
This is a condition associated with chronic alcoholism, frequently encountered in hospitalized alcoholics who have suddenly stopped alcohol. The underlying cause is liver delipidization and hemolytic anemia. This is distinct from alcoholic hepatitis which may be present simultaneously or develop later. The syndrome is defined by excessive blood lipoprotein, jaundice and abdominal pain.
Most common symptoms due to long-term history of chronic alcoholism include:
Vomiting after heavy drinking
Hepatomegaly, enlarged spleen, late cirrhosis
Skin and yellow sclera
Hemolytic Anemia, Hemoglobinuria (hemoglobin is excreted in urine) and Hemosiderin (insoluble form of storage iron complex) in urine.
Hepatic dysfunction, Jaundice, Hyperlipidemia and reversible hemolytic anemia after alcohol abuse are prominent symptoms.
Causes of Zieve's Syndrome
Zieve's syndrome is caused by alcoholism due to liver cell damage and various degrees of cholestasis thus causing cancer. Fatty liver production of free fatty acids into blood stream, increased triglycerides that causes hyperlipidemia and increased cholesterol and phospholipid deposition, and damaged red blood cells which become hard and brittle and blocked by splenic sinusoids. In addition, alcoholism induced pancreatitis and vitamin E deficiency is associated with hemolysis.
Diagnosis of Zieve's Syndrome
The diagnosis is based from objective information about alcoholism, and blood test for the abnormalities. It is based on history and the triple disease – jaundice, hemolytic anemia and hyperlipidaemia. For jaundice, moderate and direct bilirubin test is done. Hemolytic anemia is visible in hemoglobinuria and hemosiderin urine. There could be drop in hemoglobin, reticulocytes, bone marrow erythroblastic hyperplasia, and increased erythrocyte fragility and shortened life of red blood cells.
Hyperlipidemia is detected by increase in cholesterol, triglycerides and phospholipids. Diagnostic tests include hemoglobin, bone marrow examination, blood lipids including cholesterol, phospholipids, triglycerides, serum bilirubin, alkaline phosphatase, and liver function test and liver biopsy. Ultrasonography is done to reveal the syndrome. There could be rapid serum level rise after alcohol withdrawal in patients with denial of drinking.
Temperance for two to three weeks is essential for symptoms to disappear. A diet high in sugar-protein, vitamins and hepatoprotective drug is necessary. In addition to jaundice, treatment for high blood cholesterol and hemolytic anemia are essential. Basic therapy includes bed rest, adequate food intake, hydration and vitamin supplementation. The patient usually recovers from the symptoms very quickly, but the disease can recur if alcohol abuse persists.
Though the occurrence of Reye's Syndrome is rare, it is a potentially life-threatening condition. Typically, a patient suffering from Reye's syndrome has elevated levels of ammonia and acidity in the blood and reduced blood sugar levels. There is swelling in the liver and in serious cases in the brain. This can lead to a comatose condition. Usually this syndrome occurs in children under 15 years; though there has been a substantial decrease in the number of cases. Usage of aspirin to treat a viral infection is thought to be one of the factors that triggers Reye's syndrome in children and teenagers. Often Reye's syndrome is confused with meningitis, encephalitis or mental illness. It is essential to treat this condition in the early stages, lest it lead to permanent brain damage. Usually Reye's Syndrome is preceded by a viral illness. The symptoms of Reye's syndrome are nausea, rapid breathing, unusual sleepiness and lethargy. Other symptoms are persistent vomiting and diarrhea. The affected child might exhibit bizarre behavior. In a matter of a few hours, the condition can worsen and there can be seizures or convulsions and loss of consciousness. There may be muscle function loss or paralysis of the arms or legs.
A child affected by Reye's Syndrome must be given adequate fluids and electrolytes. It is essential There must be balanced and nutritional food. If there is difficulty in breathing, a respirator can provide relief. Medication is given to reduce intracranial pressure. Avoid food that upsets the child's stomach and try and keep the fever under control. A variety of diagnostic tools ranging from head CT Scan or MRI to spinal tap (lumbar puncture) and liver biopsy can help in detecting Reye's syndrome. In addition to blood and urine tests, a spinal tap is conducted to rule out meningitis or encephalitis. Liver biopsy is useful in ruling out diseases of the liver.
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Bibliography / Reference
Collection of Pages - Last revised Date: October 19, 2019