Hepatic biopsy is a diagnostic procedure in which the biomaterial is taken from the liver for histological and cytological examination.
This diagnostic manipulation is considered to be quite complicated and is carried out only in the presence of a number of indications.
The main value of biopsy research is the ability to accurately determine the origin of the disease, the stage and extent of its development, the extent of fibrotic changes, etc.
Indications
There is a misconception that a hepatic biopsy is prescribed in cases where the doctor suspects oncology.
In fact, testing for pack processes is by no means the only reason for the appointment of a biopsy study, which is shown:
- To establish the extent of damage and damage to hepatic tissues;
- If there are signs of hepatic pathologies in the analyzes;
- In case of doubt in the diagnosis after instrumental-hardware diagnostics such as ultrasound imaging tomography by computer or magnetic resonance imaging, radiography, etc.;
- To identify hereditary pathologies;
- For the purpose of an overall assessment of the survival of the transplanted liver;
- For planning treatment activities;
- To evaluate the effectiveness of the prescribed therapy;
- If there is an unconscionable elevated bilirubin content or a change in transaminase activity.
Usually a biopsy specimen from the liver is prescribed for pathologies like:
- Alcoholic liver damage;
- Chronic forms of hepatitis B, C;
- Obesity of the liver of non-alcoholic origin;
- Autoimmune hepatitis;
- Biliary cirrhosis of primary type;
- Wilson-Konovalov Pathology;
- Sclerosing cholangitis of a primary nature.
Contraindications
When administering a liver biopsy, contraindications to the procedure should be considered:
- When there is no safe access to hepatic tissues;
- In the unconscious state of the patient;
- Presence of mental disorders in the patient;
- Ascites, which are characterized by fluid accumulation in the abdominal region;
- Blood flow disorders;
- Violations of the permeability of the vascular walls, characteristic of atherosclerosis, hypertension, varicose, etc.;
- In case of allergic reactions to anesthetic drugs;
- Presence of inflammatory and suppurative organ pathologies, etc.
Types of
Several techniques are used to collect a biopsy. The final method is selected by the doctor and agreed with the patient.
Usually patients are offered several techniques:
- Laparoscopic biopsy - performed under operating conditions. The patient is placed on the operating table, a general anesthetic is administered. In the abdomen, several punctures or small incisions are made through which the necessary instruments and a micro-video camera are inserted, so the entire process is displayed by the doctor on the monitor.
- Puncture biopsy - is performed with a syringe aspirator. The puncture needle is punctured in zone 7-9 of the rib, and the syringe is filled with a biopsy. The procedure is controlled by an ultrasound machine or is performed blindly.
- Transvenous( intermittent) - is indicated for contraindications for entering the abdominal cavity( blood flow disorders, ascites, etc.).The patient is made a small incision in the jugular vein, inserts a catheter into it, advances it to the hepatic veins and, having entered into them, perform a biological sampling using a special needle.
- Intrusion biopsy( open) - performed during open surgery, when the doctor performs partial removal of the tumor or liver. The procedure is the most invasive of all listed, therefore it has several more complications than the others.
Preparation of
To ensure the procedure maximum success, it is necessary to comply with all requirements for its preparation.
- Beforehand notify the doctor about the presence of chronic pathologies, if any;
- If you are allergic to medication - always inform the specialist;
- It is necessary to tell about the drugs taken, including those that dilute the blood.
- About 7 days before the biopsy, the use of blood thinning drugs like aspirin, NSAIDs and others is stopped, but the refusal of admission must necessarily be agreed with the doctor who prescribes these preparations;
- Before the procedure, the patient donates blood to determine the degree of coagulation and to exclude contraindicated diseases, infections, etc.
How is liver biopsy done?
The patient is preliminarily examined by ultrasound to chart the sites for the fence.
The patient is placed on the couch, hands behind his head. Anesthetize the areas where the injection of the needle will be performed.
At the time of obtaining a bio-sample, the patient must lie still. So that he calms down, the patient is given sedatives. Then the doctor introduces the needle, and pushes the necessary volume of the biopsy into the syringe.
With a laparoscopic technique, several punctures are made on the abdomen, they are injected with a tool that illuminates, visualizes the procedure and produces a plucking of the tissue sample.
Evaluation of results
Results are usually ready in a week and a half. Interpretation of results is performed in several ways:
- Metavir Index. Usually used for hepatitis C, helps determine the degree of inflammation and the stage of its spread;
- Ishaq;
- Technique The Knodel. Assesses the degree of necrotic changes, inflammatory lesions, the level of scarring in the liver tissues.
This diagnostic technique is especially effective for fatty hepatic dystrophy or hepatitis of a persistent type, as well as for alcoholic cirrhosis.
Consequences of
The safety of a liver biopsy depends on the qualifications of the specialist performing it. Most often, the liver biopsy is accompanied by complications such as:
- Pain syndrome. This is the most common complication that occurs after a biopsy sampling. Usually tenderness, dull, non-intensive, takes about a week. If the discomfort is pronounced, then prescribe anesthetics.
- Bleeding. Some patients suffer from bleeding complications. If the blood loss is intense, then a blood transfusion or an operation to eliminate bleeding is necessary.
- Damage to neighboring structures. A similar complication usually occurs with a blind method of obtaining a biopsy, when a doctor can damage a gallbladder, lungs, etc. with a needle.
- Infection. Typically, this effect is relatively rare. It occurs when bacterial agents penetrate through the incision or puncture into the peritoneal cavity.
Care after
procedure Only needle biopsy of the liver is performed on an outpatient basis, in other cases the patient is hospitalized.
Approximately 4-5 hours after the procedure, doctors monitor the patient's condition, carry out ultrasound diagnostics, track the blood pressure indicators, and conduct an examination.
If negative symptoms like unbearable pain and bleeding are absent, the patient is discharged.
The first day should be abandoned driving vehicles, and the next week involves the refusal to use anti-inflammatory drugs, the exclusion of intensive physical work and thermal procedures( heating, sauna, bath).
Patient Reviews
Elena:
Have a liver biopsy due to an incomprehensible diagnosis. I was terribly afraid, because for me everything connected with hospital procedures causes silent horror. I went to the clinic, they took me to the treatment room. She undressed, lay down on the couch, the hocks trembled. The doctor cheered, gave a sedative, then made an anesthetic injection in the area of the liver. The right hand should be placed under the head. I did not feel the pain, although the pressure of the needle was felt and there was some discomfort. But this is better than doing it in an open way, when a full-fledged operation is being carried out. And in 4 hours my husband brought me home.
Anna:
I had to go through this procedure so that the doctors could determine how effectively the treatment was administered. I have hepatitis B. The procedure is quite sensitive, but not fatal, and is easily tolerated. I was given a syringe, but after the puncture they told me to lie on my stomach all day. But there were no complications, and the pain passed the day through 4. Therefore, one should not be afraid, sometimes such diagnostics are extremely necessary. In my case, the prescribed therapy was not just useless, but also damaged the liver.
Price for liver biopsy
The procedure for obtaining a biopsy from the liver tissues in the Moscow medical institutions is not a cheap pleasure, it will cost about 5000-26000 rubles.
Liver biopsy video: