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pathology.pptx

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pathology.pptx

  1. 1. pathology
  2. 2. Objectives/contents of the talk • Audience should under stand – • Indications of liver biopsy • Process of sending liver biopsy to lab/adequacy • Basic liver structure and function • Special stains –helping in the diagnosis of liver diseases • Elaboration of few famous terms in liver pathology . • Word about transplant pathology
  3. 3. Indication of liver biopsy Diagnosis •Identification and staging of parenchymal and cholestatic liver diseases -alcoholic liver disease -non-alcoholic steatohepatitis -autoimmune hepatitis -primary biliary cirrhosis -primary sclerosing cholangitis -metabolic and mitochondrial storage liver diseases such as Wilson’s disease, hemochromatosis,glycogen storage and Gaucher’s disease •Evaluation of persistent abnormal liver biochemical tests after negative or inconclusive serologic workup •Evaluation of the type and extent of drug-induced liver injury •Evaluation of fever of unknown origin or immunocompromised patients with hepatomegaly or elevated liver enzymes levels •Diagnosis of multisystem infiltrative disorders - Identification and determination of the nature of focal/ diffuse intrahepatic abnormalities on imaging studies Prognosis - Staging of known liver disease •Evaluation of pre-transplant living-related donor •Evaluation of post-transplant patient with abnormal liver tests (rejection vs. infectious aetiology) Management – Developing treatment plans based on histologic analysis •Pre-treatment evaluation and staging of chronic hepatitis •Evaluation of effectiveness of therapies for liver diseases (eg, autoimmune hepatitis)
  4. 4. Indications of liver biopsy • Due to invasive procedure –the indications have decreased • History ,biochemical profile, Autoimmune investigation, radiology and genetic markers . • Transient elastography –can measure fibrosis more directly
  5. 5. Adequacy of the biopsy • Clinical picture/history and suspected diagnosis • Should be taken by 16 gauge needle • Atleast -2-3 cm in length-1.4mm width • Containing 11 (CPT)Complete portal tracts (AASLD) • Represent about 1/50000th of whole liver • Cirrhosis can be missed 10-30% of cases • AASLD(American association for the study of liver diseases)
  6. 6. How to send to laboratory • Fixative -10% buffered formal saline • Fresh –frozen section –fat analysis ,copper, iron
  7. 7. Normal liver ANATOMY
  8. 8. NORMAL LIVER ANATOMY
  9. 9. Between cords of hepatocytes are a specialized capillary system called hepatic sinusoids, which are perfused with blood from the hepatic artery and portal vein.

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