Liver biopsy and procedure

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.

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

4. Methods Percutaneous blind Percutaneous image guided Transvenous-TJ Laparoscopic

5. What are the Needle used? Suction needle- Menghini , Jamshidi , Klatskin Cutting needle- Tru -cut, spring loaded needle

6. Procedure

7. Indications Drug-induced hepatitis Chronic hepatitis B or C Discordance in NIT and clinical feature Suspected concomitant liver disease Post-antiviral therapy Chonic cholestatic liver disease MRCP negative biliary obstruction PBC- staging and progression Small duct PSC

8. Continued.. Fatty liver- steatohepatitis Steatosis Ballooning Lobular inflammation Before LT Occult fibrosis Steatosis Inflammation SOL in liver- indistinguishable from primary vs secondary

9. Continued.. Unexplained hepatomegaly Unexplained liver enzyme elevation Storage disease

10. 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

11. 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

12. Scoring system Knodell Modified knodell / Ishak Metavir Ludwig system- PBC

13. 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.

14. 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

15. Complications Hemorrhage Hematoma Infection Capsular perforation Biliary peritonitis Pleurisy and perihepatitis Hemobilia Puncture to other organs A-V fistula

16. Thank You