Liver biopsy

Description:

For establishment of a condition of body which is in an inflammation stage carry out a liver biopsy. This method of a research in hepathology is applied from the middle of last century.
By means of this procedure by a puncture of skin, hypodermic fatty tissues and a liver a special tissue extractor carry out a material intake that then to send for diagnosing to laboratory where receive fabrics of this body (биоптат), its sizes small at all, length makes no more than two centimeters, and diameter of one millimeter. However carry sometimes out a wedge-shaped biopsy when for establishment of the diagnosis it is necessary биоптат the bigger size, for this purpose carry out the section of the wedge-shaped site of a liver.
As the biopsy of a liver represents rather disease process, it is recommended to be carried out only in certain cases as it is fraught with emergence of complications. This reason is main for carrying out selective approach to this diagnostic procedure.

Purposes of performance of a biopsy of a liver:

Most often a liver biopsy for:
- Detalizirovaniya of results of ultrasonography, magnetic and resonant or computer tomography;
- the definitions of the reasons of deviations shown in results of tests for hepatic enzymes;
- specifications of origins of a hepatomegalia (increase in a liver);
- establishments of the reasons of sudden emergence of yellowing of skin, emergence of jaundice.
There are some medical institutions in which this research is conducted to all patients, having a hepatitis C disease, in others – do only to that patients at whom the virus of a genotype 1 is revealed: as they only in 50% of cases safely recover interferonam therefore the condition of a liver should be kept under control and to timely make changes to the scheme of therapy.
To patients at whom the started form of a disease is observed to carry out a puncture biopsy of a liver, it is not considered correctly as this procedure is followed by certain damages of an organism that can worsen the general condition of the patient. The biopsy of a liver becomes by results of the next researches: the general blood test and biochemical, and also after carrying out a research of a leykotsitarnoyformulykrova. It is considered that after the patient recovered from a disease hepatitis of S type, to carry out a liver biopsy in it there is no need. Performance of this research is carried out only after appointment of the hepatologist.

Liver biopsy at hepatitis C:

Carrying out a biopsy of a liver is the most specific tool for identification of the nature and level of injury of a liver at hepatitis C. Importance of holding a procedure is explained by the accuracy of diagnosis and an exception of other associated diseases, definitions of a stage and level of hepatitis C. The biopsy allows both the patient, and the doctor to be convinced of correctness of the diagnosis once again. In addition, it is possible to call the procedure a starting point in forecasting of further development of a disease.

At establishment of level of activity of hepatitis C it is necessary to take into account, in addition, existence of an intraatsinarny, portal and periportal inflammatory infection, and also different options of a necrosis and injury of hepatocytes (a drain, step and lytic focal necrosis, апотоз hepatocytes and a focal inflammation, a portal inflammation). By and large, allocation of a stage and level of hepatitis C can have a certain predictive value and exert impact not the choice of tactics of treatment of the patient, but neither the forecast, nor the course of hepatitis can be foreseen if activity of replication of an infection was not revealed. And also, if the analysis of an immune response was not carried out, the response of the patient to antiviral therapy is not defined, information on superinfection was not obtained.

The liver biopsy at hepatitis C though is invasive, but patients transfer it very quietly. The procedure is not followed by further development of complications since today carries out not blindly as earlier, and under ultrasonic control that it fully prevents damage of vessels and the subsequent developing of bleedings.

How to be prepared for a liver biopsy:

Before performance of a biopsy the patient makes blood test where its coagulability is checked. If the patient suffers from allergic reaction to medicines, he has heart troubles, lungs or the problems connected with coagulability of blood, it is necessary to report about it to the doctor. It is necessary to stop reception of various medical supplies which increase risk of developing of bleeding. In addition, the doctor needs to report about reception of anticoagulants, before the procedure the doctor can offer the alternative method promoting blood fluidifying.
In seven days prior to carrying out a research it is necessary to stop administration of drugs, containing aspirin and antiinflammatory drugs (Indocinum, the Ibuprofen, Motrinum and so forth). The treating doctor will explain for what period it will be necessary to stop reception of these drugs and when it is possible to renew it. Consider independently to stop accepting drugs it is impossible, only after consultation with the doctor.

Technology of carrying out biopsy of a liver:

This research is conducted as follows:
the patient keeps within on a back, for the head stuffs up the right hand and during capture of a bioptat keeps a full immovability;
for psychological tranquility of the patient can give it the drugs having obshcheeuspokaivayushchy effect on TsNS;
the place in which the puncture will be carried out before holding a procedure is disinfected and anesthetized, then do a cut of the small size and through it enter the special needle intended for a biopsy by means of which take away a small fragment of tissue of liver.

Types of a biopsy of a liver:

In addition to a puncture biopsy of a liver there are other its types, carry sometimes out a laparoscopic and transvenous biopsy.
The laparoscopic biopsy is applied in that case when it is necessary to investigate a specific sample of fabric. It is carried out by a section of a wall of an abdominal cavity through which it is entered лапараскоп, representing a thin tube, on its end there is a camera thanks to which the image of a liver is visualized on the monitor. The doctor, looking at the monitor, takes the necessary fragments of fabric from necessary sites of a liver.
The transvenous biopsy is carried out if at the patient the problems connected with coagulability of blood are observed or when in an abdominal cavity there is a liquid. The doctor in a vein, being on a neck, enters a thin tubule on which there is a special needle for a biopsy, thus, advances it on veins to a liver and then takes fabric.

Results of a biopsy of a liver:

There are several ways of assessment of results, such as: method Metavir and method Knodel. The method Metavir is developed for interpretation of results of researches of patients, having a disease of hepatitis of S type. The biopsy helps to establish a stage of an inflammation and its degree depending on which the balls which are ranging from 0 to 4 where "0" means that there is no inflammatory process are celebrated, and "3" and "4" balls say that there is a heavy inflammation. The stage of inflammatory process gives an opportunity to speak about scarring and volume of the fibrous fabric which is in a liver.
These stages of fibrosis have the same assessment from 0 to 4 points where:
"0" demonstrates that there are no hems;
"1" point - the minimum scarring;
"2" - there is a scarring which extended out of liver limits;
"3" - development of bridge-like fibrosis when affected areas of a liver, in this way rally among themselves;
"4" balls demonstrate deep scarring or development of such disease as cirrhosis.
Method Knodel still has the name "method of histologic activity". It though is slightly more difficult if to compare it to method Metavir, but many doctors consider him by the most exact tool, helping to establish weight of an inflammation of a liver and its defeat. This method is characterized by assignment of four points, together they define a uniform index, the first component revealing a bridge-like necrosis or periportal, it is characterized by changes, being ranging from 0 to 10. The portal inflammation of a liver and its necrosis of shares is defined by the following two components, they are ranging from 0 to 4.
Connection of these three markers speaks about liver inflammation degree, so:
"0" - there is no inflammation;
from "1" to "4" balls demonstrate the minimum level of an inflammation;
"5-8" - there is a small inflammation;
"9-12" - the moderate inflammation is observed;
from "13" to "18" - these indicators display that there is a considerable inflammation.
The fourth component characterizes extent of scarring of a liver, it fluctuates from "0", it speaks about that, hems are absent and to "4" - there is an extensive scarring or such disease as cirrhosis. At a liver disease the obtained data on extent of inflammatory process and a phase of fibrosis helps the doctor with performing therapy.

Complications after a liver biopsy:

In case of holding a procedure Silvermen's needles in 0.15% cases observed lethal outcomes. After the biopsy began to be done by Mengini's needles, death comes 100 times less often. The analysis of death after a biopsy showed that lethal outcomes are connected, first of all, with the most rough disturbances of observation of patients after holding a procedure. According to today's data, in case of strict observance of all conditions risks of development of life-threatening diseases and complications are close to 1:18000.

The liver biopsy, the price which in private clinics can be overstated today, in rare instances leads to bleeding which source most often is an intercostal artery and a branching of intra hepatic vessels. In most cases, the clinical picture can be found in bleeding within several hours:  the doctor can state weakness, tachycardia, pallor of an integument. Isolated cases when even after 8 hours no symptoms of bleeding were observed are described.

Such rare, late bleedings became the basis for cancellation of out-patient punctures. Earlier in some countries the procedure was carried out on an outpatient basis – the patient in policlinic was detained for 5-10 hours then released. Today stay of the patient in medical institution is considered obligatory within 22-24 hours. Only after that it can be released or transferred to the hospital mode.

After the liver biopsy is carried out, the most frequent complications it is possible to call a perihepatitis and traumatic pleurisy. After a biopsy in the next hour or day pain in the field of carrying out a puncture appears. For elimination of these pains reception of analgetics often suffices. Carrying out X-ray inspection for an exception of pheumothorax and an exudate in a pleural cavity is recommended. Extremely seldom the intra hepatic hematomas which are not demanding usually surgical intervention are found.