Other Procedures

Liver Biopsy

What is an Liver Biopsy?

Liver BiopsyThe liver is located in the right upper abdomen, behind the ribs. There are many different problems that may occur in the liver and some may cause permanent damage. These conditions include viral infections, reactions to drugs or alcohol, tumors, hereditary conditions, and problems with the body’s immune system.

The liver biopsy helps to answer questions that the physician has with regards to the patient’s condition. The biopsy is a small sample of liver tissue which is prepared and stained in a laboratory, so the pathologist can view it microscopically. This helps the physician make a specific diagnosis and determine the extent and seriousness of the liver condition.

What should I expect during a Liver Biopsy?

The liver biopsy is usually performed on an outpatient basis and takes approximately 15 to 20 minutes. A mild sedative may be given to the patient prior to the procedure. An ultrasound is used to identify the best location to perform the biopsy. After the physician determines the location, the patient lies quietly on the back. That area of the skin where the biopsy will be done is carefully cleaned. A local anesthetic is used to numb the skin and tissue. A specially designed needle is inserted through the skin into the liver and a small core of tissue is obtained.

Post Procedure: The patient is kept at rest for several hours following the exam. Medical personnel monitor the heart rate and blood pressure during this time. Before being discharged, the patient instructions will be provided about returning to normal eating and activities. Activity is usually restricted for a day or so after the biopsy.

What are the prep instructions for a Liver Biopsy? – Click for Prep Instructions.

When is an Liver Biopsy performed?

The liver biopsy helps to answer questions that the physician has with regards to the patient’s condition. When a physician evaluates a liver condition he will take a medical history and perform a physical exam. Blood studies, known as liver function tests (LFT), give an overview of the health of the liver. If LFT results are persistently abnormal, the physician will then perform additional medical studies to determine the cause of the problem.

Will my insurance pay?

Do not make the mistake of asking your insurance company, “Is it covered?” Use these detailed questions to get accurate answers about how much your insurance company will pay and how much they will make you pay.

  1. How much is my deductible? Your deductible is the amount you have to pay the doctor before your coverage begins.
  2. How much is my coinsurance?  (Example: “80/20 Coinsurance” means only after your deductible is paid the insurance company pays 80% and patient pays 20% of the cost.)
  3. Please tell the allowable cost for CPT code 76942.
  4. Please confirm that Drs. Dewan, Turk, Beyer and Sharma are participating providers? View Participation List.
  5. Do I have to use preferred facilities for procedures, x-rays, labs, and hospital admissions?
  6. Explain any potential costs from the facility, pathologists, anesthesiologists or other healthcare professionals.

Special Note: Increasingly insurance policies have up to $5,000 deductibles. If your deductible is not met before a procedure we may ask that you set up a payment plan before scheduling. This proactive approach lets you make informed decisions and avoid surprises.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

ERCP is a specialized technique used to view the ducts (drainage routes) of the liver, gallbladder, and pancreas (the drainage channels from the liver are called bile ducts or biliary ducts).

An endoscope (flexible thin tube) is passed through the mouth, esophagus and stomach into the duodenum (first part of the small intestine). After the common opening to ducts from the liver and pancreas is identified, a catheter (narrow plastic tube) is passed through the endoscope into the ducts. Contrast material (dye) is then injected into the ducts (pancreatic or biliary) and X-rays are taken.

When is ERCP used?

ERCP is used when it is suspected a person’s bile or pancreatic ducts may be narrowed or blocked due to:

  • tumors
  • gallstones that form in the gallbladder and become stuck in the duct
  • inflammation due to trauma or illness, such as pancreatitis—inflammation of the pancreas
  • infection
  • valves in the ducts, called sphincters, that won’t open properly
  • scarring of the ducts, called sclerosis
  • pseudocysts—accumulations of fluid and tissue debris

What are the possible complications of ERCP?

ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Although complications requiring hospitalization can occur, they are uncommon. Complications can include pancreatitis (inflammation of the pancreas), infections, bowel perforation and bleeding. Some patients can have an adverse reaction to the sedative used. Sometimes the procedure cannot be completed for technical reasons.

Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. Patients undergoing therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing diagnostic ERCP. Your doctor will discuss your likelihood of complications before you undergo the test.

Hepatitis C

Author: Frank W. Jackson, M.D.

The Liver

Hepatitis-C-1The liver is the largest organ in the body. It is found high in the right upper abdomen, behind the ribs. It is a very complex organ and has many functions. They include:

  • Storing energy in the form of sugar (glucose)
  • Storing vitamins, iron, and other minerals
  • Making proteins, including blood clotting factors, to keep the body healthy and help it grow
  • Processing worn out red blood cells
  • Making bile which is needed for food digestion
  • Metabolizing or breaking down many medications and alcohol
  • Killing germs that enter the body through the intestine

The liver shoulders a heavy work load for the body, and almost never complains. It even has a remarkable power to regenerate itself. Still it should not be taken for granted. The liver is subject to illnesses, such as hepatitis B, which may lead to serious liver damage.

What is Hepatitis C?

Hepatitis C is caused by a virus (medically abbreviated as HCV). This type of viral hepatitis is different from the others in an important way. All patients with hepatitis A and most with hepatitis B develop an acute infection, recover completely, and develop antibodies that protect them from ever getting the disease again. However, the hepatitis C virus is a “quick-change” artist. Once inside the body, it changes its form to evade discovery and attack by the immune system. Scientists have already identified many forms of HCV, and patients infected with one type are not necessarily safe from other types. Hepatitis C patients do develop antibodies, but they are not curative or protective as in hepatitis A or B. Hepatitis C antibodies may not completely rid the body of the virus. Therefore, most people infected with the HCV virus will develop chronic hepatitis.

Hepatitis-C-2Current estimates are that 3.5 million Americans carry the virus that causes hepatitis C, and 150,000 people become infected with HCV each year. This virus is known to be spread through infected blood, blood products, and needles. Prior to the late 1980s, people were most at risk for contracting the disease through blood transfusions. However, a blood test was developed at that time to detect the virus, and the blood supply is now always tested to prevent spread of the disease in this way. Even so, there is a very slight risk for those who must receive blood products on a regular basis, such as hemophiliacs and patients on hemodialysis. Health care workers are also at risk. At this time, the people most at risk for getting hepatitis C are IV drug users who share needles. There are also a larger number of cases among east Asians. In about 40% of all cases of hepatitis C, it is unknown how the patient was infected with the virus. This situation is known as community acquired disease.

Symptoms and Diagnosis

Most patients with hepatitis C do not have symptoms. This is especially true early in the disease. If there are symptoms, they are usually mild and flu-like — perhaps nausea and fatigue. It can take from 2 to 26 weeks for the disease to develop once the patient is infected with HCV. Routine blood tests will show an elevation in certain liver enzymes, especially one called the ALT. The physician can then order a specific blood test to determine if the patient has hepatitis C.

Chronic Hepatitis C

Hepatitis-C-3Hepatitis C is a cause for concern for two reasons. First, most cases become chronic. Second, patients seldom become acutely ill, so it is possible for them to have the disease for some time before it is diagnosed. Late in the disease, fatigue may become increasingly severe. If cirrhosis has developed, other more serious symptoms may occur. However, the elevation in the blood ALT may not correlate with the degree of liver inflammation. In other words, a high ALT may not necessarily mean there is a serious degree of inflammation. Conversely, a low or normal blood ALT level may be present even though there is chronic liver damage. For this reason, a liver biopsy is almost always required to determine how serious the disease may be. Under local anesthesia, a slender needle is inserted into the right lower chest. A small piece of liver tissue is taken out with the needle and examined under a microscope. A biopsy can show if cirrhosis is present and how far it has progressed. It is believed that about 20% of the patients with chronic hepatitis C will develop cirrhosis, and a few of those will go on to develop liver cancer. It may take from 10 to 40 years for serious liver damage to occur.

Treatment

Hepatitis-C-4Both the patient and physician have a role in treating hepatitis C. It is now known that alcohol use, even in socially accepted amounts, makes the liver disease worse. So while the virus is present in the body, it is best to avoid alcohol altogether. Patients should also discuss the use of over-the-counter medicines with the physician. Some drugs such as acetaminophen (Tylenol) that may not be normally toxic can worsen liver damage in HCV. Of course, a healthy diet is always important. The patient will also want to discuss vaccination against hepatitis viruses A and B. If a person with HCV becomes infected with either of these other viruses, the outcome could be quite severe. The patient should be careful to avoid the possibility of getting these other diseases. This means no IV drugs or unprotected sex with a new partner with unknown sexual activity history.

Now to medicines. As of 1999, there are two programs available to treat HCV. One is the use of interferon (IFN) by itself. IFN is a synthetic form of a substance the body naturally produces to fight infections and strengthen the immune system. There are some bothersome side effects with the drug, such as fatigue and flu-like symptoms following each injection. Usually, interferon is injected three times a week for at least six months and often for a year. The second treatment is to combine IFN with an oral medication called ribavirin. This is particularly helpful in treating those patients who have not responded to IFN alone. A side effect of ribavirin is a mild anemia or low red cell count in the blood.

In the spring of 2011, the FDA approved two new drugs that improved the ability to treat and clear HCV infection. These are Incivek (telaprevir) and Victrelis (boceprevir). They are reserved for patients with a genotype 1 (the most common in the United States) and one or the other of these newer therapies is used in addition to interferon and ribaviron. Close monitoring and compliance are essential with all these treatments and you will want to discuss these with your physician.

Hepatitis-C-5HCV Carriers

Certain people infected with HCV have a positive HCV blood test, but a normal liver enzyme test. These individuals are often called HCV carriers, and they can pass the virus on to others. Although they appear not to be seriously ill, there is recent evidence that even these people may have chronic hepatitis. Therefore, each should be evaluated by a liver specialist.

Sex and Pregnancy

The risk of transmitting HCV sexually is low compared to hepatitis B and AIDS. In marriages and long-term relationships with monogamous partners, it is often the case that one person is HCV positive and the partner is HCV negative. The current medical recommendation is that in these circumstances, sexual practices need not be changed. However, when people have multiple sex partners or new partners, they should never engage in unprotected sex.

It appears that in pregnancy, HCV is passed on to the fetus less than 5% of the time. It may depend on how high the mother’s blood virus level is during pregnancy. Therefore, hepatitis C infected women should always consult with their physicians before becoming pregnant.

Prevention

There is no vaccine currently available to protect against hepatitis C, as there is with hepatitis A and hepatitis B. People can prevent getting hepatitis C by not sharing anything that is likely to hold and transmit blood — razors, manicure tools, toothbrushes, and especially IV drug needles. Practices such as ear piercing and tattooing should be avoided in places where sterile conditions are questionable. Until all circumstances under which HCV can be transmitted have been thoroughly identified, it should be assumed that every person with hepatitis C can pass the virus on to others. Therefore everyone, especially health care workers, should avoid coming in contact with blood and body fluids from infected individuals.

Liver Transplantation

Liver transplantation is a newer, successful form of therapy for people with a badly damaged liver. Liver transplants have become more common for people with chronic hepatitis C who develop life-threatening liver damage. However, since these patients continue to carry the virus, they will almost always reinfect their new livers. Nevertheless, with continuing treatment for the chronic infection, liver transplantation offers these patients longer life and improved quality of life.

Summary

Hepatitis C is a serious disease that often results in long-term complications. Many patients infected with HCV develop chronic hepatitis C. Some people become carriers of HCV without knowing it. For this reason it is important to prevent spread of the disease by lifestyle practices that avoid contact with infected blood and body fluids. Researchers are continually learning more about hepatitis C, and research into new treatments is ongoing. Chronic hepatitis C patients who are monitored frequently and follow the advice of their physicians have every reason to be hopeful about the future.

Bravo / Manometry

The Bravo™ pH Monitoring System is a catheter-free way to measure pH.

The Bravo system involves a pH capsule, about the size of a gel cap, that is temporarily attached to the wall of the esophagus. The Bravo™ pH Capsule measures pH levels in the esophagus and transmits readings via radio telemetry to the Bravo™ Receiver worn on the patient’s belt or waistband. The patient also records symptoms he or she experiences in a diary by pressing buttons on the receiver. The Bravo pH capsule collects pH measurements for up to 48 hours. After the study, data from the receiver is uploaded to a computer and diary information is entered for analysis to aid in the diagnosis and plan treatment. Normal patient activities such as swallowing, eating and drinking should cause the disposable pH capsule to detach and pass through the digestive tract in 5-7 days on average.

How is the Bravo pH capsule attached to the esophagus?

The doctor uses the Bravo™ Delivery System to insert the pH capsule through the mouth or nose and position it above the lower esophageal sphincter. Once the pH capsule is in place, suction is applied, drawing a small amount of esophageal tissue into the capsule and locking it in place. The delivery system is then withdrawn and the pH capsule can begin measuring pH levels.

Please read about an EGD and the EGD Prep for additional information.

Biologic Infusion

BiologicOur infusion suites in Kalamazoo and Battle Creek offer an alternative to high costs and long waits in impersonal hospitals. Infusion Nurse Specialists provide care that is prescribed by the patient’s physician and maintain close coordination and communication with the physician throughout the prescribed course of treatment.

Offering Relief from Ulcerative Colitis & Crohn’s Diseases

Ulcerative Colitis and Crohn’s are both inflammatory bowel diseases (IBD). Symptoms include diarrhea, abdominal pain, weight loss, and fatigue. Ulcerative colitis affects only the inner lining of the colon, while Crohn’s can affect the entire wall as well as the entire digestive tract. Treatments include Aminosalicylates (5-ASAs), steroids, immunosuppresants, and biologic therapy (infusion and injection).

Intravenous infusions, and therapeutic injections work with the body’s immune system to target inflammation in your digestive tract. They have been proven to maintain remission, and reduce or completely eliminate symptoms. Please ask one of our physicians or physician assistants about this treatment, if you have been diagnosed with Crohn’s or Ulcerative Colitis. We can discuss treatment options that best suit your individual needs.

KGH Office

1535 Gull Road, Suite 105
Kalamazoo, MI 49048
P: 269-385-9900
F: 269-385-2140
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DHC Office

3770 Capital Ave, SW, Suite B
Battle Creek, MI 49015
P: 269-385-9900
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Westside Office

6565 West Main Street, Suite C
Kalamazoo, MI 49009
P: 269-385-9900
F: 269-385-2140
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