Liver Biopsy Question

I was diagnosed with NASH a couple of years ago.  I had lots of blood tests and lots of things were ruled out.  Pravachol was doubled to 80 mg and I was seeing the doctor about every 6 months. The doctor is a hepatologist at a university hospital in Chicago.
In December my liver enzymes skyrocketed due to taking a Zpak, antibiotic.  I ended up in the ER and developed jaundice.  My AST was 196, ALT 289 and Alk. Phos. was 408.  
A couple of weeks later I had an US, it showed fatty infiltration, and my liver and spleen are enlarged.  This week my blood work showed that my enzymes are down - AST is 98, ALT 124 and Alk. Phos. is 287.
The hepatologist said that he wants to do a biopsy because he no longer thinks I have NASH.  My numbers are too high for me to have NASH.  He is now thinking along the lines of PBC or autoimmune cirrhosis.
Can someone tell me how a liver biopsy is done? Is it painful? How long does it take to get the results?  Any answers would be helpful, the more I think about this the more frightened I become.
Thanks so much.

[6man6]

do you mean the enzime levels should be too high to have biopsy? does that mean that your enzime levels ST is 98, ALT 124 and Alk. Phos. is 287. are not high enough to have NASH? Do you have pain in right quadrant below liver also?

[Lisa1150]

The doctor said that the enzyme levels are too high and they fluctuate too much for me to be diagnosed with NASH. He no longer thinks I have NASH.  I will be having a biopsy.

[mikesimon]

How is a biopsy done?
A hollow needle is inserted into your liver and withdrawn to obtain a sample(s) of your liver tissue.

Different people have different experiences but my experience is that the majority of people experience very little, if any, pain. I have had 8 or 9 biopsies and never experienced any pain. Biopsies are frequently ultrasound guided - to locate the site for the tissue sample. I prefer ultrasound guided biopsies so you might inquire whether that is the approach they'll be using with you.

The turn around time really depends on your physicians. If the pathologist examines the samples soon after the procedure and completes the report you could know within a few days. But, it can take a week or longer depending on your doctors and their workload. I always say that the anticipation is worse than the procedure because, like most people, I hate waiting and worrying. If you can, just shut it out of your mind because it is what it is and you'll deal with that when you know what's going on. My Mother always told me - Son, don't borrow trouble. And though it's hard not to worry I'm always better off what I can shut it out of my head.

Good luck Lisa.
Mike

[Lisa1150]

Thanks for the info and advice Mike!  
An interactive radiologist will be doing the biopsy, so it probably is Ultrasound guided.  My doctor said that he wants more than one sample. I can't wait until this is done and over with.  I don't want to borrow any trouble, I have enough already!

[mikesimon]

Hi Lisa,

I was in a rush so neglected to mention the waiting afterward.

After the procedure you will have to stay at the hospital and lie down for 2 to 3 hours. This is to insure that you're not bleeding.

More than one sample is always a good idea and so to are ultrasound guided liver biopsies. It sounds like you're in good hands and that makes all the difference in the world.

A little personal history:

I had hep c which necessitated a liver transplant in June 2000. After my transplant the hep c recurred and infected my new liver. I had to treat the hep c, which wasn't pleasant by any means, and I did have a couple of acute organ rejection episodes. I tell you this because throughout the first year I worried incessantly. I was always trying to be prepared for the worst and that meant expecting the worst. And what I learned is that we are never really prepared for the worst and trying to be prepared for the worst is a waste of precious time spent anxiously imagining every bad possibility. After a while I started expecting the best. I just put all the negative possibilities out of my mind and expected a good outcome. If I got bad news I dealt with it - like we all deal with this stuff - we have no choice. But I reduced my anxiety level significantly by simply shutting the negatives out of my mind. I hope you can find some peacefulness while you wait for the procedure and then wait for the results. Today my liver function is good and I don't have hep c anymore. There is always really good reason for maintaining hope and optimism even when we think the days are darkest. I wish you all the best Lisa.

Mike

[Lisa1150]

You're right, a positive attitude is the best way to approach things.  I was reading too much info on line and I got really frightened, of the unknown. Thanks for the reality check, I needed it;)

[Lisa1150]

I had the liver biopsy yesterday. You were so right, didn't hurt a bit!  I am so glad it is done.  I see the hepatologist next Saturday for the results. Meanwhile, I have developed a rash. It now covers my entire torso.  It started off on the right side of my torso, so I thought it might be a reaction to something that was used to disinfect my skin.  Now it covers the entire left side of my torso.  Small bumps, no redness, starting to itch.  Any ideas?

[mikesimon]

I really don't have an idea. I always think allergic reaction but I'm sure you've thought of that.

Hey, I hope the rash resolves soon.

Good luck,

Mike

[Lisa1150]

I got the results of my liver biopsy and am still trying to digest the bad news. I have Autoimmune Hepatitis and probably also have Primary Biliary Cirrhosis. The hepatologist said that I have both of these diseases and that he would speak to the pathologist to determine which one is the primary process, whatever that means. Does anyone know why is it so important to know which one is dominant?
The report states that I have grade 2 of 4 chronic hepatitis with rosetting, focal plasmacytosis and rare focus of lymphocytic cholangitis. Stage 0 or no fibrosis. No stainable iron, copper or a1at globules. The histological features are suggestive of autoimmune hepatitis. With focal lymphasitic cholangitis, there is a potential component of PBC. However, this needs, serological, clinical and LFT correlation.
The hepatologist said that the course of action is to watch my liver enzymes, testing every 3 months.  If my AST or ALT rise to the 200 level, he would put me on Predisone and another drug.
Also, now that I have been off my statin for a couple of months, my cholesterol is in the mid 300s.  He said that I don't need to restart my statin because these higher cholesterol levels do not contribute to heart disease in someone who has these two liver diseases.  Does anyone here have high cholesterol along with liver disease and not taking a statin?
Lastly, I was told that I should drink a lot of coffee and give milk thistle a try.
I am making an appointment to see a doctor for a second opinion at the Hepatobiliary clinic at Mayo in MN.  Until then, any suggestions?  Is there a good book out there that will help me learn about these diseases? I have been reading a lot lately, but just pieces here and there.  I would be great to find a good resource in one spot.
Oh, I guess its time to move to a different forum, I will post this in the cirrhosis forum as well.
Thanks so much!
Lisa

[mikesimon]

I know this news must be extremely hard to assimilate - to digest, as you said.

I think you're very wise to get a second opinion from Mayo. Mayo is a top notch institution and I would trust their personnel completely.

High cholesterol seems to not pose a big risk in PBC patients but that is not the case with patients who have other types of liver disease. PBC is different in that regard and in fact, I did read an article that raised the possibility that statin use can trigger PBC in some patients. So, it's probably prudent to stop statin use at this point.

On a positive note it appears that your liver shows no fibrosis and that is a very good thing.

Just stay hopeful and don't look too far down the road Lisa.

I wish you the very best.

Mike

[mikesimon]

I would post your question at the liver transplant expert forum. The doctor answers questions that are not transplant related. Here is the link to that site.

http://www.medhelp.org/forums/Liver-Transplant/show/274


Mike