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Indications for liver biopsy

Indications for liver biopsy
Diagnosis, grading, and staging of alcoholic liver disease, nonalcoholic steatohepatitis, and autoimmune hepatitis
Grading and staging of chronic hepatitis B and C*
Diagnosis of:
  • Hemochromatosis (quantitative estimation of hepatic iron)
  • Wilson disease (quantitative hepatic copper)
  • Focal liver lesions
Evaluation of:
  • Cholestatic liver disease: primary biliary cholangitis, primary sclerosing cholangitis
  • Abnormal liver biochemical tests in a patient with a negative or inconclusive serologic work-up
  • Treatment efficacy
  • Side effects of treatment regimens (such as methotrexate for rheumatoid arthritis)
  • Post-liver transplant by protocol or for evaluation of abnormal liver biochemical tests
  • Donor liver
  • Fever of unknown origin
* Because of the development of newer hepatitis C treatments that are effective and tolerable, staging of liver disease prior to hepatitis C treatment may not be necessary. Refer to UpToDate topics on the treatment of hepatitis C for details.
Adapted from: Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344:495.
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