Liver biopsy

Biopsy is the study of the biological material, which is the tissue of a particular organ. His fence presents certain difficulties and dangers, so before appointing this type of research, doctors should be assured of the appropriateness of the risk.

During operations with removal of the organ or part of it, tissues must be sent to a biopsy to confirm the correctness of the diagnosis. A liver biopsy is used when there is a need for differential diagnosis of diseases, when other techniques need clarification because of their imperfection.

How is the biopsy examined?

The extracted material is called a bipter. It is delivered to the laboratory, where it is possible to conduct research in three directions:

• pathomorphological analysis - is to identify changes in the composition and shape of cells( cytology), tissue elements( histology), refers to the most common method of diagnosis;
• immunohistochemical method - allows using a special treatment to reveal the chemical composition of the material, in the diagnosis of liver disease is important in Wilson-Konovalov's disease( show the sign - the deposition of copper in cells);
• biological culture method - makes it possible to isolate the pathogen of infection directly from the affected organ, determine its sensitivity to antibiotics for subsequent treatment( important for liver abscesses).

A "column" of tissue 10-40 mm high, weighing 10-50 mg

is considered sufficient for the analysis. When is biopsy necessary?

. Whichever way a biopsy is performed, it is always necessary to penetrate the liver( invasive method).In the arsenal of the doctor there are enough methods, including laboratory and instrumental, to address the issue of diagnosis. In complicated cases, laparoscopy is resorted to - introducing an optical device through the incision of the peritoneum to examine the surface structural changes in the liver.

Indications for organ biopsy are determined by complex tasks, the answer to which can be obtained only with the help of an in-depth examination of the organ tissues:

• comparative diagnosis of liver diseases with tumors( benign, malignant), detection of signs of hyperplasia, cirrhosis, fibrosis, steatosis;
• detection of metastases in the liver in cancer of other organs;
• determining the prevalence and severity of pathological changes;
• finding out the aggressiveness of inflammation in viral hepatitis, fibrosis with cirrhosis;
• if hereditary pathology is suspected;
• the need to monitor the effectiveness of the treatment if drugs and methods are used that require the study of cellular composition;
• for assessing the condition of the donor liver after transplantation.

In practice, there are patients who have significantly changed biochemical samples, high transaminases, bilirubin are determined for unclear reasons. It is in the patient's interest to have a biopsy to exclude viral hepatitis.

The nature of the detected morphological changes indicates the type of pathology

The study is necessary not only for cancerous liver damage, but also in cases:

• of non-alcoholic fatty hepatosis;
• of chronic hepatitis C or B;
• of primary biliary cirrhosis;
• alcoholic liver disease;
• autoimmune hepatitis;
• of primary sclerosing cholangitis;
• of Wilson-Konovalov's disease.

Who should not have a biopsy?

Contraindications for the biopsy procedure are severe disorders of blood clotting, bleeding, decompensation of heart and respiratory function, severe deficiency, coma of the patient, liver cancer with decompensated stage of cirrhosis.

If there is a suspicion of a hemangioma of the liver( swelling from the plexus of the blood vessels) the approach to biopsy should be very careful. The method is justified only if it is necessary to exclude another neoplasm.

With subcapsular localization, hemangioma can give marked internal bleeding. In each case, the physician selects an allowable type of biopsy, taking into account the purpose of the study, the risk of complications and the patient's condition.

Copper deposition in liver cells with Wilson-Konovalov disease

What types of biopsy are used in practice, what should the patient choose?

There are different ways of biopsy, they have their advantages and disadvantages. Percutaneous or puncture biopsy - the method is most common, less traumatic for the patient. It can be performed both in the operating clinic and in the hospital.

The patient is laid on his back, his right hand is taken away from the head. Puncture biopsy of the liver requires practical skills from the surgeon, preliminary study of the results of the research. The proposed puncture site is treated with antiseptics, with the aim of anesthetizing it is injected with a Novocaine syringe. A small incision of the skin is made between the lower extremities.

A special needle with a wide opening is inserted into it. To prevent the possibility of injury to lung tissue, the puncture is performed against the background of exhalation. You may need an additional needle to insert from a different angle. From the puncture of the liver, the doctor pushes the syringe with suction( the method is also called "aspirating").

The liver gets into the needle. After a biopsy, the patient is recommended to lie on his right side. For observation it is enough from two hours to a day. There is a "blind" method, when the doctor uses only his knowledge of anatomy, and "sighting", conducted under the supervision of ultrasound.

It is clear that in the first case there is no need for high qualification of personnel, the risk of complications is higher, there is no need to count on good material quality. If there is a hardware control, the result will be more reliable, but the method of investigation is more expensive for the medical institution or the patient.

Transjugular biopsy - is performed under stationary conditions under the control of an X-ray apparatus. The patient lies on the X-ray table. Place of anesthesia is the projection of the jugular vein on the neck.

A small incision is made on the skin and a catheter with a flexible probe is inserted into the jugular vein with screwing movements. When approaching the hepatic vein, a contrast agent is injected, taking photographs confirming the localization of the catheter. Then the probe takes the material for analysis. The catheter is removed carefully, and a bandage is applied to the wound.

Laparoscopic biopsy - allowed only in a hospital, anesthesia is needed. To do this, the patient is injected intravenously with a substance with a general analgesic effect, he quickly falls asleep. A small incision is made in the abdominal region above the projection of the liver. Through it, the necessary tools are inserted into the cavity of the peritoneum with a video camera at the end.

Modern technology allows you to display the image on the monitor screen, shows the surgeon the liver, allows you to select the site for sampling. Opportunities exceed the puncture method. At the end of the manipulations, the tools are removed, 1-2 stitches are applied to the incision. The method is contraindicated in peritonitis, expressed obesity.

The biopsy set includes a thin long needle and a wider trephine.

A targeted trepanobiopsy is performed using a special instrument( trephine) wider than the needle. Therefore, it receives a massive tissue site, you can capture a dense fibrous focus. Open method - used in the surgical incision, when the patient is given complete anesthesia and interference is supposed. It seems most reliable and effective.

The patient, after determining the indications, is informed by the specialists how a liver biopsy is done in a particular institution. According to the legislation, the patient must sign the informed consent the same as when preparing for the operation. For children, the decision is made by the parents.

The best way to choose a doctor. For example, if you suspect a cancer tumor, conducting a "blind" puncture study does not make sense. The method also depends on the equipment available in the clinic, trained specialists. Therefore, when deciding where to do a patient's examination, it is necessary to take into account all aspects of the issue, to get acquainted with the reviews about a particular clinic.

How is the training conducted?

To determine the indications and to exclude contraindications before the procedure, the doctor must check the blood clotting indices, the ultrasound of the liver and abdominal organs is performed, the women are examined by a gynecologist. Blood tests for viral hepatitis and AIDS are given.

A patient taking anticoagulants, non-hormonal anti-inflammatory drugs should drop them one week before the proposed biopsy. This is necessary for the prevention of bleeding. The doctor should report all chronic illnesses and allergic reactions that the patient suffers.

Tips after procedure

Although a biopsy is not considered a highly traumatic operation, but it requires recovery, like any intervention. At the puncture site, small pain can last up to two days. The patient needs control, measures blood pressure and pulse, and listens to breathing.

Strict bed rest is required for 2-4 hours with a puncture biopsy, after other types - the doctor can get up. If the procedure was carried out in a polyclinic, after 4 hours it is allowed to go home. During the day you should monitor the regime, move less, do not lift weights.

It's better not to drive a car, the head of

may be spinning. What do they write in the conclusion of the analysis?

Depending on the type of biopsy specimen, laboratory results may indicate:

• for the detection of atypical tumor cells;
• change in the tissue of hepatic inflammatory lobules;
• fibrosis and replacement of hepatic cells with scar tissue;
• stagnation of bile in the passages with compression of the lobules;
• presence of a parasitic or infectious focus.

For hepatitis C, the virus activity index is calculated, the degree of replacement of the liver parenchyma by connective tissue. For specialists, scoring scales are developed in terms of the revealed pathology.

What are the possible complications?

Conducting a controlled biopsy and sufficient qualification of the doctor ensure that there are no complications. They occur very rarely in the form:

• internal bleeding( getting into the hemangioma, vessel);
• wounds with perforation of the biliary tract, intestines, stomach with peritonitis;
• damage to lung tissue with the development of pneumothorax;
• introduction or activation of the spread of infection, followed by the formation of liver abscess, general sepsis.

How is biopsy performed in children?

Young children are injected with a sedative, local anesthesia. Seniors may need general anesthesia. The puncture biopsy is often used. The child is fixed to the operating table with special straps. On exhalation the assistant squeezes the chest of a small patient, at this time they make a puncture of the liver.

Before the biopsy the child must have ultrasound

Children have complications in 4.5% of cases, which is higher than in adults. Especially the risk of bleeding after the transplantation of bone marrow has been increased.

The most common complications:

• inflammation in the pleural cavity( pleurisy);
• perihepatitis - the spread of inflammation to the surrounding cellulose;
• bleeding;
• intrahepatic hematomas;
• bile peritonitis;
• formation of arteriovenous fistula in the portal of the liver;
• infection.

In modern medicine, the question of expediency of a method of examination at a high risk and presence of complicating factors is rigidly posed. Doctors are aware of this and should inform patients about the significance and possibilities of the forthcoming procedure.

A liver biopsy is a necessary method only if one can hope for the benefit of the results if it is impossible to obtain it by other methods of investigation.