Approach to medical liver biopsies Dr Behrang Mozayani
Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol
Indications for biopsy o o o Abnormal unexplained liver function tests Evaluation of diagnosis, grade and stage of disease Unexplained cholestatic liver disease FUO Suspected hepatic tumour Post transplantation
Size of biopsy o o …biopsy of at least 2 -3 cm in length and 16 -gauge in calibre is recommended (AASLD position paper) Current UK standard: minimum 15 mm and 6 portal tracts. Often 18 gauge
Cases o o o Most common diagnosis Should be straight forward Not always one answer without clinical information
Case 1 o o o 68 year old female Abnormal lfts Episodes of pruritus AMA positive Raised alk phos and Ig. M
diagnosis o Primary biliary cirrhosis
Case 2 o o o 57 year old male Episodes of Jaundice and pruritus High alk phos, low GGT ALTs 200 s Abnormal hepatic duct on MRCP
diagnosis o o Chronic large duct obstruction Wider differential
Case 3 o o 61 year old male Generally unwell ALTs 300 s On hormone therapy for prostate cancer
diagnosis o Central perivenulitis/acute hepatitis
Case 4 o o 80 year old male Sudden onset of jaundice Acutely unwell Autoantibodies negative
diagnosis o Acute hepatitis
Case 5 o o o 25 year old male Known UC Abnormal LFTs
diagnosis o Primary sclerosing cholangitis
Case 6 o o o 54 year old male Ultrasound suggests cirrhosis ? cause
diagnosis o Steatohepatitis and incomplete cirrhosis
Case 7 o o o o 61 year old female Feeling tired, poor appetite ALT 500 s Ig. G raised ANA+ Viral serology negative No drug history
diagnosis o Autoimmune hepatitis
Case 8 o o 60 year old male High ferritin in work up C 282 Y homocygote Normal lft’s
diagnosis o Genetic haemochromatosis
Case 9 o o 64 year old female Cirrhosis Heart failure Abnormal lft’s
diagnosis o o Cirrhosis ? Aetiology A 1 AT deficiency
Case 10 o o 22 year old female Abnormal lfts and fibroscan Low caeruloplasmin, high serum copper Chromosome 13 mutation
diagnosis o Wilson’s disease
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