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Approach to medical liver biopsies

Learn the essential aspects of medical liver biopsies, including indications, recommended biopsy size, common cases, and diagnostic insights provided by Dr. Behrang Mozayani, a seasoned Consultant Histopathologist at Southmead Hospital Bristol.

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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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