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Liver Biopsy

Dr. HelloDox Care #
HelloDox Care
Consult


Overview
A liver biopsy is a procedure to remove a small piece of liver tissue, so it can be examined under a microscope for signs of damage or disease. Your doctor may recommend a liver biopsy if blood tests or imaging studies suggest you might have a liver problem. A liver biopsy is also used to determine the severity of liver disease. This information helps guide treatment decisions.

The most common type of liver biopsy is called percutaneous liver biopsy. It involves inserting a thin needle through your abdomen into the liver and removing a small piece of tissue. Two other types of liver biopsy one using a vein in the neck (transjugular) and the other using a small abdominal incision (laparoscopic) also remove liver tissue with a needle.

Why it's done
A liver biopsy may be done to:

Diagnose a liver problem that can't be otherwise identified
Obtain a sample of tissue from an abnormality found by an imaging study
Determine the severity of liver disease a process called staging
Help develop treatment plans based on the liver's condition
Determine how well treatment for liver disease is working
Monitor the liver after a liver transplant
Your doctor may recommend a liver biopsy if you have:

Abnormal liver test results that can't be explained
A mass (tumor) or other abnormalities on your liver as seen on imaging tests
Ongoing, unexplained fevers
A liver biopsy also is commonly performed to help diagnose and stage certain liver diseases, including:

Nonalcoholic fatty liver disease
Chronic hepatitis B or C
Autoimmune hepatitis
Alcoholic liver disease
Primary biliary cirrhosis
Primary sclerosing cholangitis
Hemochromatosis
Wilson's disease
Risks
A liver biopsy is a safe procedure when performed by an experienced doctor. Possible risks include:

Pain. Pain at the biopsy site is the most common complication after a liver biopsy. Pain after a liver biopsy is usually a mild discomfort. If pain makes you uncomfortable, you may be given a narcotic pain medication, such as acetaminophen with codeine (Tylenol with Codeine).
Bleeding. Bleeding can occur after a liver biopsy. Excessive bleeding may require you to be hospitalized for a blood transfusion or surgery to stop the bleeding.
Infection. Rarely, bacteria may enter the abdominal cavity or bloodstream.
Accidental injury to a nearby organ. In rare instances, the needle may stick another internal organ, such as the gallbladder or a lung, during a liver biopsy.
In a transjugular procedure, a thin tube is inserted through a large vein in your neck and passed down into the vein that runs through your liver. If you have a transjugular liver biopsy, other infrequent risks include:

Collection of blood (hematoma) in the neck. Blood may pool around the site where the catheter was inserted, potentially causing pain and swelling.
Temporary problems with the facial nerves. Rarely, the transjugular procedure can injure nerves and affect the face and eyes, causing short-term problems, such as a drooping eyelid.
Temporary voice problems. You may be hoarse, have a weak voice or lose your voice for a short time.
Puncture of the lung. If the needle accidentally sticks your lung, the result may be a collapsed lung (pneumothorax).
How you prepare
Before your liver biopsy, you'll meet with your doctor to talk about what to expect during the biopsy. This is a good time to ask questions about the procedure and make sure you understand the risks and benefits.

Stop taking certain medications
When you meet with your doctor, bring a list of all medications you take, including over-the-counter medications, vitamins and herbal supplements. Before your liver biopsy, you'll likely be asked to stop taking medications and supplements that can increase the risk of bleeding, including:

Aspirin, ibuprofen (Advil, Motrin IB, others) and certain other pain relievers
Blood-thinning medications (anticoagulants), such as warfarin (Coumadin)
Certain dietary supplements that may increase risk of uncontrolled bleeding
Your doctor or nurse will let you know if you need to temporarily avoid any of your other medications.

Undergo blood tests
Before your biopsy, you'll have a blood test to check your blood's ability to clot. If you have blood-clotting problems, you may be given a medication before your biopsy to reduce the risk of bleeding.

Stop eating and drinking before the procedure
You may be asked not to drink or eat for six to eight hours before the liver biopsy. Some people can eat a light breakfast.

Prepare for your recovery
You may receive a sedative before your liver biopsy. If this is the case, arrange for someone to drive you home after the procedure. Have someone stay with you or check on you during the first night. Many doctors recommend that people spend the first evening within an hour's driving distance of the hospital where the biopsy is done, in case a complication develops.

What you can expect
What you can expect during your liver biopsy will depend on the type of procedure you'll undergo. A percutaneous liver biopsy is the most common type of liver biopsy, but it isn't an option for everyone. Your doctor may recommend a different form of liver biopsy if you:

Could have trouble holding still during the procedure
Have a history of or likelihood of bleeding problems or blood-clotting disorders
Might have a tumor involving blood vessels in your liver
Have an abnormal amount of fluid in your abdomen (ascites)
Are very obese
Have a liver infection
Before the procedure
A liver biopsy is done at a hospital or outpatient center. You'll likely arrive early in the morning. Your health care team will review your medical history, including the medications you take.

Just before your biopsy you will:

Have an IV line placed, usually into a vein in your arm, so that you can be given medications if you need them
Possibly be given a sedative to help you relax during the procedure
Use the toilet if needed because you'll need to remain in bed for a few hours after the procedure
During the procedure
The steps involved in liver biopsy vary according to the type:

Percutaneous biopsy. To begin your procedure, your doctor will locate your liver by tapping on your abdomen or using ultrasound images. In certain situations, ultrasound might be used during the biopsy to guide the needle into your liver. You'll lie on your back and position your right hand above your head on the table. Your doctor will apply a numbing medication to the area where the needle will be inserted. The doctor then makes a small incision near the bottom of your rib cage on your right side and inserts the biopsy needle. The biopsy itself takes just a few seconds. As the needle passes quickly in and out of your liver, you'll be asked to hold your breath.
Transjugular biopsy. You'll lie on your back on an X-ray table. Your doctor applies a numbing medication to one side of your neck, makes a small incision and inserts a flexible plastic tube into your jugular vein. The tube is threaded down the jugular vein and into the large vein in your liver (hepatic vein). Your doctor then injects a contrast dye into the tube and makes a series of X-ray images. The dye shows up on the images, allowing the doctor to see the hepatic vein. A biopsy needle is then threaded through the tube, and one or more liver samples are removed. The catheter is carefully removed, and the incision on your neck is covered with a bandage.
Laparoscopic biopsy. During a laparoscopic biopsy, you'll likely receive general anesthetics. You'll be positioned on your back on an operating table and your doctor will make one or more small incisions in your abdomen. Special tools are inserted through the incisions, including a tiny video camera that projects images on a monitor in the operating room. The doctor uses the video images to guide the tools to the liver to remove tissue samples. The tools are removed and the incisions are closed with stitches.
After the procedure
After the biopsy, you can expect to:

Be taken to a recovery room, where a nurse will monitor your blood pressure, pulse and breathing
Rest quietly for two to four hours, or longer if you had a transjugular procedure
Feel some soreness where the needle was inserted, which may last as long as a week
Have someone drive you home, since you won't be able to drive until the sedative wears off
Avoid lifting more than 10 to 15 pounds for one week
Be able to get back to your usual activities gradually over a period of a week
Results
Your liver tissue goes to a laboratory to be examined by a doctor who specializes in diagnosing disease (pathologist). The pathologist will look for signs of disease and damage to the liver. Your biopsy report should come back from the pathology lab within a few days to a week.

At a follow-up visit, your doctor will explain the results. You may be diagnosed with a liver disease, or your liver disease may be given a stage or grade number based on the severity mild, moderate or severe. Your doctor will discuss what treatment, if any, you need.

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This common drug may cause liver failure

Dr. HelloDox Care #
HelloDox Care
Consult

Turns out, acetaminophen, a common pain reliever, is the leading cause of acute liver failure. In the liver, acetaminophen is converted into a new compound that covalently binds to proteins at an amino acid called cysteine. These covalent binding events are known to contribute to the toxicity of acetaminophen, but they cannot fully account for its role in the liver failure.

The compound is known to impair the activity of mitochondria, the cell`s energy supplier, but does not bind directly to some of the enzymes in mitochondria whose activity it affects. Researchers at the National University of Singapore have found a new way that how the breakdown product affects proteins in the liver. They examined glutathionylation, a post-translational modification made to cysteine residues, in response to acetaminophen toxicity and reported a new proteomic approach to isolate and identify glutathionylated proteins and applied it in cells treated with acetaminophen.

Researchers also found that an acetaminophen breakdown product can cause glutathionylation, suggesting a new mechanism for the damage the drug causes. Usually, glutathione is added to cysteine residues to protect them from damage by oxygen under stressful conditions. The modification affects proteins involved in mitochondrial fuel uptake and energy production, leading to metabolic dysfunction and other effects linked to acetaminophen toxicity. This research helps explain the drug`s toxicity at high doses, especially among enzymes that are impaired by acetaminophen treatment without binding directly to the drug or its metabolites. The findings appeared in the Journal of Molecular & Cellular Proteomics.

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यकृत बायोप्सी

Dr. HelloDox Care #
HelloDox Care
Consult

आढावा
यकृत बायोप्सी ही यकृत टिशूचा लहान तुकडा काढून टाकण्याची प्रक्रिया आहे, म्हणून तो एखाद्या सूक्ष्मदृष्टीने नुकसान किंवा रोगाच्या लक्षणांसाठी तपासली जाऊ शकते. रक्ताच्या चाचण्या किंवा इमेजिंग अभ्यासातून आपल्याला यकृत समस्या असल्याचे सूचित केल्यास आपले डॉक्टर लिव्हर बायोप्सीची शिफारस करू शकतात. लिव्हर बायोप्सीचा वापर यकृत रोगाच्या तीव्रतेचे निर्धारण करण्यासाठी केला जातो. ही माहिती उपचार निर्णयांचे मार्गदर्शन करण्यास मदत करते.

यकृत बायोप्सीचा सर्वात सामान्य प्रकार म्हणजे पेर्कुटनेस लिव्हर बायोप्सी. यात आपल्या ओटीपोटातून यकृतमध्ये पातळ सुई घालणे आणि ऊतींचे छोटे तुकडे काढणे समाविष्ट आहे. दोन प्रकारचे लिव्हर बायोप्सी- गर्दनमधील एक नसा (ट्रान्सजगुलर) आणि दुसरा उदर डोळा (लेप्रोस्कोपिक) वापरुन एक - सुईने यकृत ऊतक देखील काढून टाकतो.

हे का केले?
यकृत बायोप्सी हे केले जाऊ शकते:
यकृत समस्येचे निदान करा जे अन्यथा ओळखले जाऊ शकत नाही
इमेजिंग अभ्यासाद्वारे आढळलेल्या असामान्यपणापासून ऊतींचे नमुने मिळविण्यासाठी
यकृत रोगाचा तीव्रता निश्चित करा - एक प्रक्रिया म्हणजे स्टेजिंग
यकृताच्या स्थितीवर आधारित उपचार योजना विकसित करण्यात मदत करा
यकृत रोगाचा उपचार कसा चांगला आहे हे ठरवा
यकृत प्रत्यारोपणानंतर यकृतवर नियंत्रण ठेवा

आपल्या डॉक्टरांनी यकृत बायोप्सीची शिफारस केली असेल तर:
असामान्य यकृत चाचणी परिणाम स्पष्ट केले जाऊ शकत नाहीत
इमेजिंग चाचण्यांवर दिसत असलेल्या आपल्या यकृतावर एक वस्तुमान (ट्यूमर) किंवा इतर असामान्यता
चालू, अस्पष्ट ताप
यकृत बायोप्सी देखील सामान्यपणे यकृत रोगांचे निदान करण्यात आणि स्टेज करण्यात मदत करण्यासाठी केली जाते, यासह:

नॉन-माल्कोहिक फॅटी यकृत रोग
क्रोनिक हेपेटायटीस बी किंवा सी
ऑटिम्मुने हेपेटायटीस
मद्यपी यकृत रोग
प्राथमिक पित्तविषयक सिरोसिस
प्राथमिक स्क्लेरोयझिंग कोलांटायटीस
हेमोक्रोमैटोसिस
विल्सनचा रोग

धोके
अनुभवी डॉक्टराने केलेल्या यकृताची बायोप्सी ही एक सुरक्षित प्रक्रिया आहे. संभाव्य जोखीमांमध्ये हे समाविष्ट आहे:

वेदना बायोप्सी जागेवर वेदना यकृत बायोप्सीनंतर सर्वात सामान्य क्लिष्टता आहे. यकृत बायोप्सी नंतर वेदना सहसा एक सौम्य अस्वस्थता असते. जर वेदना आपल्याला अस्वस्थ करते, तर आपल्याला कोडेन (कोडिनयुक्त सह टायलेनॉल) सह एसिटामिनोफेनसारखे मादक औषधोपचार औषधे दिली जाऊ शकतात.
रक्तस्त्राव यकृत बायोप्सीनंतर रक्तस्त्राव होतो. रक्तस्त्राव थांबविण्यासाठी रक्तस्त्राव किंवा शस्त्रक्रियेसाठी अति प्रमाणात रक्तस्त्राव होण्याची आवश्यकता असू शकते.
संक्रमण दुर्मिळपणे, बॅक्टेरिया ओटीपोटाच्या गुहा किंवा रक्तप्रवाहात प्रवेश करू शकतो.
जवळच्या अवयवामध्ये अपघाती जखम. दुर्मिळ अवस्थेत, लिव्हर यकृत बायोप्सी दरम्यान, सुई इतर आंतरिक अंग, जसे की पित्ताशय किंवा फुफ्फुसासारखी असू शकते.
ट्रान्सजुगुलर प्रक्रियेत, आपल्या मानाने मोठ्या नलिकाद्वारे पातळ नलिका घातली जाते आणि आपल्या यकृतामधून चालणा-या शिरामध्ये फेकली जाते. आपल्याकडे ट्रान्सजुगुलर यकृत बायोप्सी असल्यास, इतर असुरक्षित जोखीमांमध्ये हे समाविष्ट होते:

मान मध्ये रक्त संग्रह (हेमेटोमा). ज्या ठिकाणी कॅथेटर घातले गेले होते त्या ठिकाणी रक्त रक्त जाऊ शकते, संभाव्यत: वेदना आणि सूज येणे.
चेहऱ्यावरील अस्वस्थांसह तात्पुरती समस्या. दुर्मिळ पलकांसारख्या अल्पकालीन समस्यांमुळे ट्रान्सजुगुलर प्रक्रिया नर्वांना इजा पोहोचवते आणि चेहरा आणि डोळे प्रभावित करते.
अस्थायी आवाज समस्या. आपण कंटाळवाणे, कमकुवत आवाज किंवा थोडा वेळ आपला आवाज गमावू शकता.
फुफ्फुसांचे पँक्चर जर सुई आपल्या फुफ्फुसांना अपघाताने मारतो तर त्याचे परिणाम पडलेले फेफड़े (न्यूमोथोरॅक्स) असू शकतात.
आपण कसे तयार आहात
आपल्या यकृत बायोप्सीच्या आधी, बायोप्सी दरम्यान काय अपेक्षा करावी याविषयी बोलण्यासाठी आपण आपल्या डॉक्टरांशी भेटू. प्रक्रियेबद्दल प्रश्न विचारणे आणि जोखमी आणि फायदे समजणे हे आपल्यासाठी चांगले आहे.

काही औषधे घेणे थांबवा:
जेव्हा आपण आपल्या डॉक्टरांसह भेटता तेव्हा ओव्हर-द-काउंटर औषधे, जीवनसत्त्वे आणि हर्बल पूरकांसह आपण घेत असलेल्या सर्व औषधांची यादी आणा. आपल्या यकृत बायोप्सीच्या आधी, आपल्याला औषधे व पूरक आहार घेणे थांबविले जाईल ज्यामुळे रक्तस्त्राव होण्याचा धोका कमी होऊ शकेल, यासह:

एस्पिरिन, यबुप्रोफेन (अॅडविल, मोट्रिन आयबी, इतर) आणि काही इतर वेदना मुक्त करणारे
ब्लड-थिंगिंग औषधे (एंटीकोगुलंट्स), जसे वॉर्फिन (कुमामिन)
काही आहारयुक्त पूरक जे अनियंत्रित रक्तस्त्राव धोका वाढवू शकतात
आपल्याला आपल्या इतर कोणत्याही औषधे तात्पुरते टाळण्यासाठी आवश्यक असल्यास आपला डॉक्टर किंवा नर्स आपल्याला कळवेल.

रक्त तपासणी करा
आपल्या बायोप्सीपूर्वी, आपल्या रक्तसंक्रमणाची क्षमता तपासण्यासाठी आपल्याकडे रक्त तपासणी केली जाईल. जर आपल्यास रक्ताची समस्या असल्यास, रक्तस्त्राव होण्याचा धोका कमी करण्यासाठी आपल्या बायोप्सीच्या आधी आपल्याला औषधे दिली जाऊ शकतात.

प्रक्रिया करण्यापूर्वी खाणे आणि पिणे थांबवा
आपल्याला यकृत बायोप्सीच्या सहा ते आठ तास आधी पिण्यास किंवा खाण्यास सांगितले जाणार नाही. काही लोक हलका नाश्ता खातात.

आपल्या पुनर्प्राप्तीसाठी तयार करा:
आपल्या यकृताच्या बायोप्सीच्या आधी आपण एक सेडेटिव्ह प्राप्त करू शकता. असे असल्यास, प्रक्रियेनंतर कोणीतरी आपल्याला घरी आणण्यासाठी व्यवस्था करा. एखाद्याने आपल्याबरोबर राहावे किंवा प्रथम रात्री आपणास तपासा. बऱ्याच डॉक्टरांनी अशी तक्रार केली आहे की बायोप्सी पूर्ण झाल्यांनतर एका तासाच्या आत गाडी चालविल्यास एखादी जटिलता विकसित होऊ शकते .

आपण काय अपेक्षा करू शकता?
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