Jaundice other diagnostic studies
Jaundice other diagnostic studies On the Web
American Roentgen Ray Society Images of Jaundice other diagnostic studies
The gold standard diagnostic test for jaundice caused by cirrhosis is liver biopsy, although it is rarely necessary for diagnosis or treatment. Sample of the liver is obtained bypercutaneous approach, transjugular approach, and laparoscopic radiographically- guided fine-needle approach. A biopsy is not necessary if the clinical, laboratory, and radiologic data suggest cirrhosis. There is a small but significant risk associated with liver biopsy, and cirrhosis itself predisposes to the complications of liver biopsy.
Other Diagnostic Studies
- Cirrhosis is primarily a histological diagnosis. The gold standard for diagnosis of cirrhosis is liver biopsy.
- Sample of the liver is obtained by:
- Percutaneous approach
- Transjugular approach
- Laparoscopic radiographically- guided fine-needle approach
- Percutaneous biopsy of focal lesions may be performed in combination with either ultrasound or CT imaging.
- Percutaneous liver biopsy remains the cornerstone of diagnosis. It is quick and simple to perform liver biopsy in a patient with normal platelet count and INR.
- Histologically, cirrhosis may be classified as micronodular, macronodular, or mixed, but this classification is nonspecific to the etiology.
- Histology of the liver may change as the disease progresses, and serological markers are much more specific.
- A biopsy is not necessary if the clinical, laboratory, and radiologic data suggest cirrhosis.
- Liver biopsy may be suggestive of etiology:
- Alcoholic liver disease: Liver biopsy may show hepatocyte necrosis, presence of mallory bodies, neutrophilic infiltration and perivenular inflammation.
- Primary biliary cirrhosis: Gold standard diagnostic modality is the detection of antimitochondrial antibodies along with liver biopsy to confirm presence of florid bile duct lesions.
- There is a small but significant risk associated with liver biopsy, and cirrhosis itself predisposes to the complications of liver biopsy.
- Risks of liver biopsy include:
- Patients with moderate coagulopathy:
- Patients with severe clotting disorders:
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The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68,000 percutaneous liver biopsies in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding.