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A liver biopsy is a test to remove tissue from the liver, which is then viewed under a microscope to identify changes in the structure of cells. Thanks to this, it is possible to diagnose a liver disease and choose a treatment method.

Liver biopsyis performed when acute viralhepatitis , chronic and active liver lesions or liver toxicities are suspected. There are two types biopsy:

  • not targeted, i.e. blind, in which the segment is obtained most often by inserting the right, middle axillary line at the height of the 9th or 10th intercostal space,
  • targeted biopsy, performed during a laparoscopic examination, ultrasound or computed tomography.

Liver biopsy is performed in a hospital under local anesthesia (in children under general anesthesia). Beforeexaminationyou must perform blood tests - complete blood count, blood group determination, liver tests and ultrasound of the liver.

Read more: Types of biopsies and their course

Liver biopsy: indications

  • unknown cause of jaundice
  • cirrhosis of the liver of unknown cause or cirrhosis of the liver of known cause to determine the possible coexistence of other diseases
  • abnormally structured areas of tissue detected by ultrasound of the abdominal cavity or by computed tomography

Liver biopsy: contraindications

  • blood coagulation disorders (platelet count less than 100 x 109 / L or prothrombin index less than 60 percent)
  • very severe jaundice
  • liver cysts and liver angioma
  • acute purulent inflammation of the gallbladder and biliary tract
  • other purulent conditions in the liver area (peritonitis, presence of right-sided subdural abscess or right-sided pleurisy)
  • pregnancy
  • patient's lack of cooperation

Liver biopsy: course

You lie on your back during the examination. To locate the liver, the doctor taps his fingers on the surface of the body in the area of ​​the right costal arch. Then he punctures the right place with a needle and introduces an anesthetic to the skin, subcutaneous tissue and the muscle layer. After 5.10 minutes, it uses a scalpel to pierce the skin and subcutaneous tissue. In the place of the little one(several millimeters) incision introduces a special biopsy needle mounted on the syringe, which - after creating a negative pressure in it - introduces it into the liver parenchyma. You have to hold your breath for a split second. After the procedure, the doctor puts on a sterile pressure dressing. The examination takes approximately 20 minutes. After the examination, you should lie on your right side for up to 3 hours with a blanket roller underneath the biopsy; then you have to lie on your back for a day.

Liver biopsy: interpretation of the result

You can wait up to 2 weeks for the result, because the collected material is sent for examination to reputable histopathological centers in Poland.

When the downloaded slice contains at least 6 portal spaces, the so-called gate, in the description we can find two values ​​on a scale of 0-4, where 0 means no pathological changes, and 4 - very serious changes, but in the description you can find intermediate entries, e.g. 0/1, 2/3, 3 / 4. If the sample taken contains 4 or less portal spaces, the result should be accompanied by a descriptive form of diagnosis (e.g. hepatitis chronica C - chronic hepatitis C).

  • Inflammatory activity (grading, g)

0 pts - no inflammatory changes in the portal spaces; 1 point - low activity: sparse infiltrates in the portal spaces, low intramedullary inflammatory activity, preserved border plaques; 2 points. - moderate activity: moderate inflammatory infiltrate in the portal spaces, single foci of bite necrosis, single foci of necrosis in lobules; 3 points. - moderate activity: bite necrosis including a minority of the border lamina circumference in all portal spaces, inflammatory activity and moderate necrosis in the lobules; 4 points. - high activity: bite necrosis covering most of the border of the border plate, high degree of medullary inflammatory activity with formation of bridging necrosis.

  • Staging range (s)

0 pts - standard - single collagen fibers in the portal spaces; 1 point. - portal space fibrosis; 2 points - periportal fibrosis and possibly single span fibrosis with the preservation of the lobule structure; 3 points. - the presence of numerous fibrous spans with disturbance of the lobule architecture without a regenerative reaction; 4 points. - disseminated fibrosis or cirrhosis. In addition, a liver biopsy can determine whether there is steatosis, neoplastic lesions, or signs of cholestasis (cholestasis). Without a liver biopsy, it is impossible to qualify for a possible treatment of chronic Hepatitis C or B.

Liver biopsy: complications

Complications are very rare (around 2percentages of cases) and they are:

  • internal hemorrhage
  • irritation or biliary peritonitis
  • puncture of the liver lobe
  • circulatory collapse
  • hematoma or pneumothorax
  • irritation of the periosteum of the ribs or intercostal nerves.

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