Liver biopsy with cancer
To establish the exact cellular composition of liver tissue, doctors use a modern approach. A liver biopsy allows the diagnosis to be fully established, when other methods of research do not yield reliable results.
What is a biopsy and what does it show?
A liver biopsy is a procedure for extracting a biopsy specimen (a sample of liver tissue) in order to clarify or establish a diagnosis. BP can accurately determine the cause of the disease, the degree of inflammation and the stage of organ damage.
Many liver diseases do not have significant signs or manifest as nonspecific symptoms that do not directly indicate the presence of pathology:
- fast fatiguability;
- discomfort in the right hypochondrium, etc.
Sometimes, studies and analyzes do not give a complete picture of the degree of organ damage, the intensity of the disease, and the effectiveness of the therapy.
To get reliable information about the condition of the inflamed organ, doctors use several methods of conducting BP:
- Percutaneous puncture.
A laboratory biopsy study allows doctors to make a final diagnosis and prescribe the necessary therapy.
Who has liver biopsy?
The main indication for BP is the specification of the features of the proposed disease. Sometimes manipulation is performed to evaluate the effectiveness of therapy for an already diagnosed disease or to assess the condition of the body before treatment with medications that can cause hepatotoxicity.
BP may be an extremely important diagnostic procedure for a number of diseases:
- hepatitis: C, B, autoimmune;
- violation of enzyme function;
- cirrhotic lesion;
- congenital anomalies.
Also, the procedure helps to detail the results of ultrasound, MRI or CT; helps to determine the causes of liver enlargement, jaundice, deviations in the results of tests for hepatic enzymes, etc. In addition, manipulation is carried out with suspicions of a malignant tumor, for the presence of metastasis in the liver.
Depending on the method of BP, there are general and specific contraindications:
- Severe hemostasis.
- Cardiovascular and respiratory insufficiency.
- Expansion of intrahepatic flows.
- Intestinal obstruction.
- Bacterial peritonitis.
- Reduced blood clotting.
- Thrombosis of hepatic veins.
Manipulation is contraindicated in patients with advanced form of the disease, tk. it is quite traumatic and there is a possibility of deterioration of the patient's health after a biopsy.
There are pathologies in which the BP is prohibited, but after normalization of the patient's condition, puncture is allowed. To such pathologies carry: a cholangitis, an inflammation of a pleura of a lung.
How to prepare for the BP?
Before the appointment procedure, the patient needs to undergo a series of examinations:
- Ultrasound of the abdominal cavity;
- CT of the liver with contrast;
- general, biochemical blood tests.
In case the patient takes medicines or has any health problems (allergy to medicines, lung, heart, blood clotting disorders, etc.) pathology), - it is necessary to notify the doctor!.
There are several mandatory conditions that the patient must comply with before the BP:
- 7 days prior to manipulation, stop taking medications that affect blood circulation, as well as anti-inflammatory drugs;
- no later than 9 hours before the manipulation to stop taking liquids and food.
Also, on the eve it is not necessary to take hot water procedures. It is recommended to have a good rest and to give up heavy physical exertion.
How is liver biopsy performed?
Percutaneous BPis more often used for hepatitis. The method is considered the least traumatic. The procedure takes place under local anesthesia and lasts a few seconds, so it does not cause significant discomfort to the patient. With the help of ultrasound or CT, doctors determine the site of the organ puncture, disinfect the skin and make a puncture to pass a biopsy cutting or aspirating needle. After receiving a biopsy specimen, a bandage is applied to the wound and the patient is assigned a 6-hour bed rest.
Transvenous BPis preferable for patients with poor blood coagulability, hemodialysis or the presence of fluid in the peritoneal cavity. The procedure is under anesthesia. A small incision is made on the patient's neck and a catheter is inserted into the jugular vein, which is gradually advanced into the veins of the liver. Using a special needle, the fragment is taken. The duration of the procedure takes from half an hour to one hour. During this time, electrocardiographic monitoring is mandatory. This method allows to obtain a sample of the liver through the vascular system of the organ, which reduces the likelihood of bleeding.
Laparoscopic PDunder general anesthesia. In the abdominal cavity, the doctors make a small incision through which a fiber-optic probe with a camera is inserted, which transmits the image on the monitor, and special surgical instruments: a loop or forceps, by which doctors take a fragment of a certain section organ. After this, hemostasis is performed - moxibustion. The method is not recommended in the presence of problems with the heart, with the respiratory system, with a blockage of the intestine.
Regardless of the method of conducting BP, during the procedure of taking a sample of tissue the patient should lie still and be in a stable psychoemotional state.
Is it painful?
BP is performed under local or general anesthesia, so the patient will not feel severe pain. During the procedure, the patient may feel a slight discomfort at the puncture site: in the right hypochondrium, in the epigastric region, above the clavicle or in the right shoulder. But often this symptomatology is associated with poor preparation of the patient, with his increased excitability or with a medical error: gross manipulation, insufficient anesthesia.
When conducting BP there is a risk of complications, therefore the procedure is performed in certain cases only by the appointment of a doctor-hepatologist.
Possible consequences and safety procedures
Biopsy is considered a relatively safe procedure when the doctor takes into account all possible contraindications, with the availability of modern medical equipment and high qualification of medical staff. However, there is always a low risk of complications after a biopsy.
The most dangerous complications after the procedure are:
- internal bleeding;
- damage to neighboring organs;
- bile peritonitis;
- pleural shock.
The percentage of serious complications after a biopsy is low - only 1%. The main side reactions of the body are moderate and weak pains in the right hypochondrium region, the presence of hematomas. In 30% of patients, this clinical symptomatology is observed.
Recovery after the BP
After 4-6 hours after the procedure, doctors observe the patient's condition, conduct ultrasound, measure blood pressure. If during the first 72 hours the patient has fever or has the following symptoms: chills; difficulty breathing; acute pain in the liver, shoulder, sternum, abdominal cavity; then the patient needs urgent hospitalization.
The first day after BP is recommended to abandon driving and physical activity. Also, in the near future it is necessary to exclude alcohol, taking anti-inflammatory drugs, taking hot water procedures, such as sauna, bath, heating, etc.
The cost of the service may vary significantly, depending on the clinic, region and method of BP. The average cost of BP in Russia is 1800 rubles, in Ukraine - 800 UAH.
The procedure can be carried out in medical institutions of different levels, therefore the following services may not be included in the cost of conducting manipulations: anesthesia, a set of instruments, a preliminary examination, the length of stay in the hospital, histological study.
The decision to carry out this manipulation is taken for each patient purely individually. Biopsy is the starting point in predicting the development of the disease. The procedure has undeniable advantages: the ability to assess the condition of the body, choose the right method of treatment and evaluate the effectiveness of the therapy.
Liver biopsy- one of the most accurate methods of research. It is simply necessary if other diagnostic methods do not allow a reliable diagnosis..