Conclusions

On entry into the study, a detailed history was taken and full physical examination was carried out and a questionnaire administered (Appendix II) to each patient giving detailed demographic and clinical data including past medical history, history of blood transfusion, use of intravenous drugs, history of jaundice, traditional surgery and laboratory data.

HCV Screening Methods:

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HCV screening was done using a rapid test strip (ACON laboratories. Inc USA), by the investigator according to the manufacturers instruction under supervision of a senior laboratory scientist. It is a qualitative, membrane-based immunoassay for the detection of antibodies to HCV antigen in the test line region of the strip. During testing, the whole blood, serum or plasma specimen reacts with the protein and coated particles. The mixture migrates towards the membrane chromatographically by capillary action to react with recombinant HCV antigen on the membrane to generate a colored line indicate a positive result, while its absence indicates a negative result.

Detailed procedure and interpretation of results are in appendix III.

Biochemical Tests:

Five milliliter of blood sample was used for biochemical tests such as serum transaminases, total protein, albumin and serum bilirubin for both patients and controls. These were done at the Biochemistry Laboratory of UMTH using a kit called BT 294 QY (Randox Lab Ltd,UK).

The sera were also tested for alpha fetoprotein, hepatitis B virus surface antigen and prothrombin - time.

Histopathological diagnosis;

Liver Biopsy

Materials used included sterile biopsy set, 2 10ml sterile plastic syringes.

sterile disposable 21G needle, sterile normal saline, antiseptic solution,

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1% lignocaine, facemask, sterile gloves, sterile gowns and sterile drapes. Others include sterile universal bottle filled with 10% formalin, filter paper, scalpel blade, minor operation set with cotton wool, gauze, gallipots, kidney dish and forceps.

Percuteaneous liver biopsy using the Menghini needle and /or fine needle aspiration biopsy using 23G needle was performed by the investigator on those who met the minimum criteria for liver biopsy.

Histopathology and cytology test were performed on the samples by a consultant pathologist in UMTH.

Procedure for percutaneous Liver biopsy

● The liver biopsy was performed at the bedside, preferably in the morning after a light break fast.

● Patient was positioned supine with right arm behind head.

● Biopsy site was exposed.

● Biopsy sequence and breath holding techniques was rehearsed with patient.

● Area of hepatic dullness was delineated by percussion, biopsy site was localized usually in the 8^th or 9^th intercostals space.

● The chosen intercostals space was carefully scrutinized for dilated blood vessels (which must be avoided) and marked.

● Skin was cleaned with an antiseptic solution.

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● Skin and subcutaneous tissue was infilterated with 1% xylocaine along proposed biopsy tract as far as the liver capsule.

● The menghini needle was assembled and attached to a 20ml syringe which contained 5ml of sterile saline.

● The trochar was inserted through the chosen biopsy site to assess the depth of the liver from the skin and to create a pathway for the cannula.

● The biopsy needle was slowly advanced through the track created until the liver capsule was reached. One million of saline was flushed through the needle to expelled skin, muscle, fragments and blood clots.

● The breathing exercise was repeated and the patient was asked to hold his breath after exhaling fully.

● Steady suction was applied to the syringe which was then rapidly advanced into the liver and rapidly withdrawn, in a smooth to - and - fro movement.

● The contents of the biopsy needle were expelled with some saline into a specimen bottle containing 10% formalin.

Post biopsy care of patients –

A dry dressing was applied over the puncture site and patient was made to lie in the right lateral position for 3 – 4 hours to ensure haemostasis. Strict bed rest was subsequently maintained for 12 hours during which vital signs were monitored initially quarter hourly and then half hourly.

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Procedure for fine needle liver aspiration biopsy.

● The procedure was performed at the bedside on patients with hepatomegaly in supine position.

● The abdomen was palpated for hepatomegaly and percussed for liver dullness. A hard nodular spot within the area of hepatomelgaly was chosen as the biopsy site and marked.

● The right hypochondrium was cleaned with antiseptic solution.

● A fine needle was then introduced to take the lesion aspirates obtained using a 10ml plastic syringe fitted with a 21 – guages disposable needle.

● The contents of the needle were blown on to a glass slide.

Post aspiration care:

Firm pressure was applied with a finger and gauze over the needle to the puncture site for about 2 minutes to ensure haemostasis. A dry dressing was then applied over the puncture site. Subsequent monitoring was similar to that detailed for liver biopsy.