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Approach to medical liver biopsies

Approach to medical liver biopsies. Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol. Indications for biopsy. Abnormal unexplained liver function tests Evaluation of diagnosis, grade and stage of disease Unexplained cholestatic liver disease FUO

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Approach to medical liver biopsies

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  1. Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol

  2. Indications for biopsy • Abnormal unexplained liver function tests • Evaluation of diagnosis, grade and stage of disease • Unexplained cholestatic liver disease • FUO • Suspected hepatic tumour • Post transplantation

  3. Size of biopsy • …biopsy of at least 2-3 cm in length and 16-gauge in calibre is recommended (AASLD position paper) • Current UK standard: minimum 15mm and 6 portal tracts. Often 18 gauge

  4. Cases • Most common diagnosis • Should be straight forward • Not always one answer without clinical information

  5. Case 1 • 68 year old female • Abnormal lfts • Episodes of pruritus • AMA positive • Raised alk phos and IgM

  6. diagnosis • Primary biliary cirrhosis

  7. Case 2 • 57 year old male • Episodes of Jaundice and pruritus • High alk phos, low GGT • ALTs 200s • Abnormal hepatic duct on MRCP

  8. diagnosis • Chronic large duct obstruction • Wider differential

  9. Case 3 • 61 year old male • Generally unwell • ALTs 300s • On hormone therapy for prostate cancer

  10. diagnosis • Central perivenulitis/acute hepatitis

  11. Case 4 • 80 year old male • Sudden onset of jaundice • Acutely unwell • Autoantibodies negative

  12. diagnosis • Acute hepatitis

  13. Case 5 • 25 year old male • Known UC • Abnormal LFTs

  14. diagnosis • Primary sclerosing cholangitis

  15. Case 6 • 54 year old male • Ultrasound suggests cirrhosis • ?cause

  16. diagnosis • Steatohepatitis and incomplete cirrhosis

  17. Case 7 • 61 year old female • Feeling tired, poor appetite • ALT 500s • IgG raised • ANA+ • Viral serology negative • No drug history

  18. diagnosis • Autoimmune hepatitis

  19. Case 8 • 60 year old male • High ferritin in work up • C282Y homocygote • Normal lft’s

  20. diagnosis • Genetic haemochromatosis

  21. Case 9 • 64 year old female • Cirrhosis • Heart failure • Abnormal lft’s

  22. diagnosis • Cirrhosis ? Aetiology • A1AT deficiency

  23. Case 10 • 22 year old female • Abnormal lfts and fibroscan • Low caeruloplasmin, high serum copper • Chromosome 13 mutation

  24. diagnosis • Wilson’s disease

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