It is a procedure where small piece of liver tissue is removed and examined to Confirm clinical diagnosis, and assess the severity, and progression treatment response of the disease.
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Liver biopsy and procedure
1. Liver Biopsy
Dr. Md. Ashiqur Rahman
Resident,
Department of Gastroenterology, BSMMU
2. What is liver biopsy?
It is a procedure where small piece of liver tissue is removed and
examine to
• Confirm clinical Dx
• Asses the severity, progression
• Rx response of the disease
• First performed by German physician Paul Ehrlich in 1883.
3. Preparation
• Consent
• Absence of followings
• Ascites
• Significant extrahepatic biliary obstruction
• Encephalopathy
• Coagulopathy- PT > 4sec and PC < 60k
• Renal failure
• CCF
• Cystic lesion in liver- Hydatid cyst
• Pre-biopsy USG for anatomical abnormalities- Chilaiditi syndrome, IH GB
13. Special application
• Immuno-histochemical study for tumor marker
• HCC vs CC
• Early HCC vs Dysplastic nodule
• HCC vs Metastatic adenocarcinoma
• HCC- Hep-par1, pCEA, CD10, CD34
• CC- cytokeratin7,19
• Early HCC- glypican-3, HSP-70
14. Interpretations
• Specimen 2 to 3cm long and contain at least 11 portal tract.
• Finding are
• Portal inflammation
• Lobular inflammation
• Ductal reaction- ductopenia >50%
• Steatosis
• fibrosis
16. Ishak scoring system
Stage Findings
1 Fibrous expansion of some portal areas ± short fibrous septa.
2 Fibrous expansion of most portal areas ± short fibrous Septa
3 Fibrous expansion of most portal areas with occasional portal to portal (P-P)
bridging.
4 Fibrous expansion of portal areas with marked bridging (poral to portal (P-P)
as well as portal to central (P-C)).
5 Marked bridging (P-P and/or P-C), with occasional nodules (incomplete
cirrhosis).
6 Cirrhosis, probable or definite.
17. Follow-up after procedure
• Vitals and complains
• Every 15 mins for 2 hours
• Every 30 mins for 2 hours
• Every 60 mins for 2 hours
18. Complications
• Hemorrhage
• Hematoma
• Infection
• Capsular perforation
• Biliary peritonitis
• Pleurisy and perihepatitis
• Hemobilia
• Puncture to other organs
• A-V fistula