The appropriate use and understanding of serum liver biochemical tests has been a source of some confusion for health care providers at all levels. There have been changes in nomenclature for some of the enzymes, adding to the confusion. More importantly, the relative usefulness of the serum tests varies by disease state, and this perhaps leads to the greatest misunderstanding of how best to use these tests. Because the liver has such diverse functions, assessing injury requires the use of multiple tests in combination, with no single test or panel being sufficient to assess liver dysfunction or disease.
The liver biopsy has evolved recently in both technique and application. Until the percutaneous biopsy technique was adopted for routine use, liver biopsy was considered a major undertaking that was performed surgically, usually via laparoscopy. It was an inpatient procedure requiring at least a 24-hour stay. Now, percutaneous biopsies are routinely performed with a variety of needles and techniques and have evolved from being an inpatient procedure to an outpatient procedure often performed with only local anesthesia. The appropriate use and timing of liver biopsies for some liver disorders is well established, but for others like hepatitis C (HC), there is no consensus about how it should best be used. In addition, there have been noninvasive assays recently developed to complement the liver biopsy and perhaps in the future supplant it.
This chapter describes the various patterns of liver enzyme abnormalities and how they correlate with hepatic disorders. It also addresses the techniques of liver biopsy and its applications.
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