Wilson's disease other diagnostic studies: Difference between revisions
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==Overview== | ==Overview== | ||
==Other diagnostic studies== | |||
===Liver biopsy=== | ===Liver biopsy=== | ||
Once other investigations have indicated Wilson's disease, the ideal test is the removal of a small amount of liver tissue through a [[liver biopsy]]. This is assessed microscopically for the degree of [[steatosis]] and [[cirrhosis]], and [[histochemistry]] and quantification of copper are used to measure the severity of the copper accumulation. A level of 250 [[microgram|μg]] of copper per gram of dried liver tissue confirms Wilson's disease. Occasionally, lower levels of copper are found; in that case, the combination of the biopsy findings with all other tests could still lead to a formal diagnosis of Wilson's. | Once other investigations have indicated Wilson's disease, the ideal test is the removal of a small amount of liver tissue through a [[liver biopsy]]. This is assessed microscopically for the degree of [[steatosis]] and [[cirrhosis]], and [[histochemistry]] and quantification of copper are used to measure the severity of the copper accumulation. A level of 250 [[microgram|μg]] of copper per gram of dried liver tissue confirms Wilson's disease. Occasionally, lower levels of copper are found; in that case, the combination of the biopsy findings with all other tests could still lead to a formal diagnosis of Wilson's. |
Revision as of 13:12, 23 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Other diagnostic studies
Liver biopsy
Once other investigations have indicated Wilson's disease, the ideal test is the removal of a small amount of liver tissue through a liver biopsy. This is assessed microscopically for the degree of steatosis and cirrhosis, and histochemistry and quantification of copper are used to measure the severity of the copper accumulation. A level of 250 μg of copper per gram of dried liver tissue confirms Wilson's disease. Occasionally, lower levels of copper are found; in that case, the combination of the biopsy findings with all other tests could still lead to a formal diagnosis of Wilson's.
In the earlier stages of the disease, the biopsy typically shows steatosis (deposition of fatty material), increased glycogen in the nucleus, and areas of necrosis (cell death). In more advanced disease, the changes observed are quite similar to those seen in autoimmune hepatitis, such as infiltration by inflammatory cells, piecemeal necrosis and fibrosis (scar tissue). In advanced disease, finally, cirrhosis is the main finding. In acute liver failure, degeneration of the liver cells and collapse of the liver tissue architecture is seen, typically on a background of cirrhotic changes. Histochemical methods for detecting copper are inconsistent and unreliable, and taken alone are regarded as insufficient to establish a diagnosis.