Liver biopsy

Liver biopsy * enables the study of the histological changes in the liver, histochemical and micro-chemical study of liver punctate. Application of electron microscopy allows the study of the liver tissue at the subcellular level.
A very significant question of to what extent the data obtained on the basis of examination of a small piece of liver, suitable for the evaluation of the condition of the whole body. A special research conducted in this direction by many researchers (Waldsten, Szanlo, 1950; Braunstein, 1956; X. X. Mansurov et al., 1963, and others)showed high diagnostic accuracy of the method biopsy of the liver.
And yet the possibility puncture biopsy as a method of study is limited by two factors: the low volume punctate and almost random, forced the place of receipt punctate when "blind" biopsy. Small size punctate often do not add up to a fair idea about the rebuilding of the architectonics of hepatic lobules. This circumstance often prevents the determination of the morphological type of cirrhosis based on the research punctate. Forced puncture site at "blind" liver biopsy relatively little impact on the diagnostic capabilities of puncture biopsy with diffuse liver diseases. But with focal lesions (granulomatosa) or diffuse, but not uniform in its scope of authorities (for example, with postnecrotic cirrhosis of the liver) can be obtained false negative result.
These defects can be reduced by holding a " sighting" biopsy, in which a place to puncture is selected visually, which gives the opportunity to explore the most suspicious area of the liver.
A. F. of Bluger (1964) sets the following indications for liver biopsy: 1) hepatomegaly obscure Genesis; 2) violations of the liver, in the absence of clinical data, explaining these violations; 3) jaundice obscure Genesis; 4) the suspect for liver tumors. It is better to carry out "pinpoint biopsy, for if the blind biopsy diagnostic value have only positive results; 5) the suspect granulomatous disease of the liver; 6) the suspect hemochromatosis, lipoids (Gaucher disease), glycogens, amyloidosis liver; 7) the need to determine the activity of the pathological process in chronic hepatitis and liver cirrhosis; 8) to get morphological data justifying the choice of the most rational methods of treatment and to monitor the effectiveness of treatment.
Contraindications liver biopsy. I. Absolute: hemorrhagic diathesis; long obstructive jaundice; suppurative processes in any part of the fabric close to the puncture site (piodermia, abscesses, purulent cholangitis, Echinococcus liver); inflammation in the right pleural cavity or the lower part of the right lung; restless heavy, coma patient.
II. Relative: the old age, hypertensive disease III stage, cardiovascular insufficiency, anemia, liver and other conditions, hindering the conduct of a puncture.
Possible complications: bleeding, biliary peritonitis, pneumothorax, pleural shock, punctures of the abdominal cavity.
Good preparation of patients, technically correct implementation of the puncture and the use of needles small diameter entirely prevent complications.

* Detail about the method biopsy of the liver see spec. user guide.: A. F. of Bluger and M. P. Sinelnikova. Lifetime morphological study of the liver. Riga, 1962; X. X. Mansurov and S. N. Koutchak. Liver biopsy. Dushanbe, 1964.