Liver biopsy.

[diddl]

So, been to consultant today & he wants to do one.

I am terrified.

The other option is a laparoscopy.

Anyone had either done?

If I could have a biopsy done whilst not awake then no problems.

It´s the being awake.

It takes all my courage to have blood taken.

Liver biopsy is an invasive procedure not doubt about it but it is done under ultrasound guidance so they can see where they are throughout the procedure. Haven't had one done but have done a few in my time. Not very long in general.

Do you why they want to do it? I would prefer a biopsy to a laparoscopy personally .

Diddl sweetheart what's it for? I am so sorry you are going through this, it must be very frightening.

also would sedation help do you think? They might well offer that if they can't put you out iyswim.

Thanks for replying.

I have high gamma gt.

Also high blood sugar & cholesterol.

Fatty liver is suspected.

Am trying with my diet but maybe not hard enough.

Ultrasound showed nothing abnormal.

I feel well.
If blood tests hadn´t shown this, no one would know iyswim.

Consultant said yesterday, "well, don´t you want to know for sure?".
Quite honestly, if the only option is sticking a needle in me, then no, not really.

And for fatty liver-what can they do-nothing!

I've had two, diddl, though neither were done with u/s guidance (just hit or miss in those days).

They didn't hurt, either of them - but I could feel the needle inside me which was very weird. The first time I found it quite shocking, because I wasn't expecting to feel it in that way. Sort of like a (non-painful) punch in the ribs, it left me feeling a bit winded. The second time, because I knew what to expect, it really wasn't bad at all.

I had a fair bit of pain afterwards, in the shoulder area (nerve related, because your liver has no pain nerve endings in it as such) and had to stay lying on my side for several hours. This is to let the hole heal up without risking a bleed. I was given paracetamol, and was fine by the afternoon. The second time, I had a bit of pain for 24 hours but again, paracetamol was enough.

I think I would need a better reason than just 'don't you want to know for sure' if there's nothing that can be done - personally, I need a reason that makes sense to me to go through any medical procedure! Can you talk to your consultant again? Or your GP, to help weigh up pros and cons?

Also, I'm sure you could be given sedation (not general anaesthetic, but something calming?) before the biopsy, if you were really scared? Worth asking about that, too.

I know several people who've had liver biopsies, and no one has enjoyed them but no one has found them really awful either, iyswim.

Thank you for that Elibean

I do know what you mean about them being "doable"

I´ve given birth twice & had a colposcopy & laser treatment, so part of me feel that I´m being a complete wuss.

Part of me feels that I don´t want an invasive and not completely without risk procedure when I don´t feel unwell.

I know that would use ultra sound & that it is standard to keep people in overnight.

I think my other "problem" is that if it confirms fatty liver, well, I´m just going to be doing what I´m currently doing-trying to improve my diet & lose weight.

But since my blood sugar & cholesterol are high, I do also feel like asking if I could try tablets for a time to see if that has any effect.

I do also see the consultant´s view that they have found something & feel the need to pursue & find out what it is.

But part of me feels why if it isn´t currently causing problems.

I can see your dilemma, it makes sense to ask all those questions. I suppose, if your consultant is wanting to confirm the diagnosis, there is a possibility of it not being fatty liver? In which case, could it be something else, something treatable?

Yes, nowadays (mine was over 10 years ago) its a much improved technique - though my friend who had a biopsy a couple of years ago didn't stay in overnight, just all day.

And FWIW, I have become much wussier since having been through lots of medical stuff in the past. I sort of feel I've had enough, and will only go through unpleasant tests if I really need to - and preferably unconsious! I do understand.

Yes I think fatty liver usually shows on a scan.

With the scan there seemed to be nothing abnormal.

But the raised gamma gt suggests there is.

What I haven´t properly asked is if high blood sugar & cholesterol can cause high gamma gt.

And it is only one raised enzyme

I´m also very worried about pain afterwards-as I say, total wuss.

And IV sedatives/pain relief!!

Hello,

I've had two, one without ultrasound and one with. The one under u/s was fine - I just laid there and was told when it was over. The one without was a surprise, like eilbean said it is like a punch in the ribs. It didn't hurt afterwards really, a bit tender maybe but certainly not painful. Although that might be because I've had a liver transplant and the nerves were cut, perhaps it hurts more with your own liver.

Both were done on the day ward but I had to lie still for 8 hours afterwards.

diddl, the pain I had after the first one was not that bad - it was like a bad stitch, but in my shoulder/neck instead of side, if that makes sense?! The second one I had only mild, burny ache after - really nothing much, and I'm a wuss - but it lasted longer.

If you only have one raised enzyme, I would have thought a re-test (blood) would be a good idea, no? And thats a good question you have, do ask it!

Re scans, though, mine was also normal and I had rapidly advancing hepatitis damage - they don't show everything. But blood tests give a lot of information.

Well I think I would certainly like to try other avenues first!

Can I ask if you are taking any meds. An isolated raised GGT can be due to enzyme induction particulalry if USS normal.

Bisoprolol for cardiac arrhythmia.

There have been mention made of raised GGT with bisoprolol. It may be worth considering alternative agents depending on your arrthymia.

Oh that´s interesting!

I only take half a tablet a day-but with raised cholesterol & blood sugar-it might be enough to tip my liver over the edge!

Raised cholesterol and blood sugar? Do you mena you have impaired glucose tolerance? Fatty liver is recognisable on uss and doesn't typically give rise to an isolated GGT.
GGT normally is abnormal with other things unless due to enzyme induction/ meds.
Do you know what you hepatologists differential diganosis is i.e. what is he/she looking for on the biopy?

No, I don´t know what they are looking for.
Fatty liver was suspected, but afaik that didn´t show up on scan.

He also said that auto immune hepatitis couldn´t be ruled out-I think he was referring to the scan.

I thought bloods would show AIH or not?

Have had high blood sugar & cholseterol for a while-often just over the top limit iyswim.

I think I would ask :

1. what the probability of having a significant liver problem with normal us/s and single enzyme derangement

2. If you have any positive auto-antibodies to suggest AIH

I wouldn't be worried about the actual biopsy what I do question the probability of the biopsy picking up something significant based on what you have said so far.

That sounds good, thank you.

I vary between thinking just have the thing done & get a diagnosis & thinking I feel fine & therefore don´t want an invasive procedure.

I get that it is a fairly "normal" procedure now & that the risks are minimal blah, blah, but I also think that Drs can be a bit gung ho in their attitude of "let´s just do a biopsy it´s the only test that really tells us anything"

My DH has recently had a load of liver investigations due to high GGT including ultrasound, various blood tests etc. Apparently the fibroscan was the most useful test, it shows how flexible the liver is and that shows if there's scar tissue etc. This was instead of a biopsy, which the specialist was not keen to recommend if avoidable.

The fibroscan was through Bupa so I don't know if it's available on the NHS, but DH was advised that a biopsy wasn't necessary in his case. hth

Well I can but ask!

jenny, might I ask what is the matter with your husband?

(Don´t answer if you´d rather not)

diddl, thing is, as Pardon says and as my consultant said, a liver biopsy will only show whats going on in that teeny sample of liver tissue. Its a big organ. So there are lots of things it won't diagnose - hence I'd want to know more before going ahead, too.

Sounds like your consultant is in for a grilling

Well, I´ve got until September to figure my questions out!

I´m sort thinking if the scan showed nothing & I feel fine, can it be left at that?

I just have visions of getting on a treadmill of endless hospital visits/tests...

And I feel fine!

There's nothing wrong with him, he needed to pass a medical and this liver stuff came up so he's had to have loads of tests to prove there's nothing wrong with him! The specialist he saw said he's fine and raised GGT is not necessarily an indicator that anything is wrong.

Apparently a biopsy is the definitive test, although the fibroscan is very useful. Good luck with your decision making!

Thank you.
(Hopes can bring own consultant round to that way of thinking!)