DOCSLIB.ORG

Liver Histology and Follow up Of68 Patients With

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Liver Histology and Follow up Of68 Patients With 468 Gut, 1990, 31, 468-472 Liver histology and follow up of 68 patients with ulcerative colitis and normal liver function tests Gut: first published as 10.1136/gut.31.4.468 on 1 April 1990. Downloaded from U Broome', H Glaumann, R Hultcrantz Abstract the colitis,4' but so far no such correlation has Hepatobiliary disorders are well known com- been found. plications in patients with ulcerative colitis but In 1966, primary sclerosing cholangitis was it is not possible to predict those patients with recognised in patients with ulcerative colitis.9 10 ulcerative colitis who will eventually devleop Initially, it was described as an unusual finding,8- liver disease. In this study, liver biopsies from 10 but with an increased awareness of the disease 74 patients with ulcerative colitis have been and with the availability of endoscopic retro- reevaluated. None of the patients showed grade cholangiography in addition to a possible clinical or biochemical signs of liver disease at absolute increase of the disease, primary scleros- the time of biopsy. Thirty seven (50%) had a ing cholangitis is today found in 2-4% of all completely normal liver biopsy. The others patients with ulcerative colitis." 12 Except for one showed minimal portal inflammation or fatty study by Perrett et al,3 who found minor histo- infiltration. The biopsies of three patients logical abnormalities in six of 13 patients with displayed concentric, periductular fibrosis, or ulcerative colitis without clinical or biochemical so called 'onion skin' lesions. None showed evidence of liver disease, little is known about other signs of fibrosis or cirrhosis. The histo- the incidence ofalterations in the liver in patients logical findings were unrelated to either with ulcerative colitis in general. Also, aetio- activity or extent ofcolitis, except for the onion logical factors leading to liver disease in patients skin lesions which were seen exclusively in with ulcerative colitis are not clarified. biopsies of patients with involvement of the In the present study liver biopsies from 74 total colon. Sixty eight of the 74 patients were patients suffering from ulcerative colitis with reviewed after a mean interval of 18 years. The normal liver function tests have been reexamined majority had no symptoms of hepatobiliary according to the new classification system ofliver disorders and only two had developed liver biopsies.'4 The patients were followed up in disease; one suffered from cryptogenic order to assess if patients with ulcerative colitis, http://gut.bmj.com/ cirrhosis, possibly due to non-A, non-B hepa- but lacking biochemical parameters of liver titis and the other of an autoimmune liver disease, run a lower risk of developing hepato- disease and later developed a bile duct car- biliary complications compared-with all patients cinoma. Both were women with total colonic with ulcerative colitis. We also wanted to estab- involvement. At the time of the first liver lish if any specific histological abnormality biopsy one showed no histological abnormali- would be of value in predicting the future risk ties and the other only minor fatty infiltration. that a patient with ulcerative colitis will develop on October 2, 2021 by guest. Protected copyright. Thus, minor abnormalities in liver tissue are liver disease. common in patients with ulcerative colitis without biochemical evidence of liver disease. The morphological changes are oflittle help in Methods predicting the future risk of a patient with ulcerative colitis developing a clinically rele- PATI ENTS vant hepatobiliary complication. The absence Between 1958 and 1968, at St Erik's Hospital in of biochemical parameters for liver disease Stockholm, Sweden, liver biopsies as well as during the early years of ulcerative colitis biochemical liver function tests were routinely predict a favourable longterm diagnosis as performed on patients with ulcerative colitis. In regards hepatobiliary complications. 78 of the patients, the liver function was more extensively examined and was found to be com- pletely normal. Four of the patients later In 1874 Thomas' described an association developed Crohn's disease and were therefore between ulcerative colitis and liver disease. Since excluded from our present study. many reports have confirmed this 3 Clinical data were obtained from the hospital Departments ofMedicine then, finding2 U Broome and it is today considered a fact that the inci- records at the time of the biopsy. There were 34 R Hultcrantz dence of liver disease in patients with ulcerative men and 40 women. The mean age at onset of colitis is greater than in the general population.3 ulcerative colitis was 31 years (8-69). At this time Infectious Diseases, and Pathology, Huddinge The most common histological findings are fatty the Ethics committee system was not operating University Hospital and infiltration and portal inflammatory cell infil- in Sweden but as far as we know informed Roslagstull Hospital, trates consisting of collections of lymphocytes consent was not obtained. The diagnosis of Stockholm, Sweden H Glaumann and plasma cells. Often, but not always, these ulcerative colitis was based on the following are and a of diarrhoea and/or rectal Correspondence to: Ulrika cells concentrated around the bile ducts, criteria: history Broome, MD, Huddinge eventually hyaline fibrous tissue surrounding bleeding for six weeks or more; at least one University Hospital, S-141 86 the mucosa Huddinge, Sweden. bile ducts may develop.2-7 There have been sigmoidoscopy showing friability of Accepted for publication attempts to correlate the histological changes with contact bleeding and/or petechial haemor- 10 July 1989 seen in liver tissue to the severity and extent of rhages and/or ulceration with intervening inflam- Liverhistology andfollow up of68patients with ulcerative colitis and normal liverfunction tests 469 mation of the mucosa, and a barium enema with 100' radiological evidence of ulceration or narrowing or shortening of the colon; and characteristic microscopical changes in the biopsy.'5 80- The extent of the colitis was determined by a'c Gut: first published as 10.1136/gut.31.4.468 on 1 April 1990. Downloaded from sigmoidoscopy and barium enema. Thirty seven ._0 patients were found to have total involvement of 60- IRemission the colon, 28 left sided involvement and nine had proctitis. The inflammatory activity ofthe colitis E Active colitis 40- had been determined. Remission was defined as CL- a state in which the patient had no bowel 0 symptoms and the sigmoidoscopy showed no 20- activity. The colitis was defined as active when the sigmoidoscopy showed oedema, excess n I * I- -11 - a mucus, signs of bleeding and/or ulceration and . M-F7- () I .f the patient had symptoms of diarrhoea. Fifteen O ' + ++ I +++ ++++ patients were in remission, and in 59 patients the Degree of portal inflammation colitis was active. Two patients had been sub- Figure 1: Comparison between the degree ofportal inflammation in patients with active colitis and with colitis in jected to cholecystectomy, and one had pre- remission. viously suffered from hepatitis A. Three patients were classified as over consumers of alcohol while the others consumed no alcohol or only all had been autopsied. The time of death was small amounts at weekends. Sulphasalazine was then taken as the time of follow up. Among the taken by 21 of the patients, corticosteroids by 17 six patients whom it was not possible to follow and local corticosteroids by 27 patients. up, we know that two women died at the age of. Guanicil, a non-absorbable sulphonamide, was 92 and 80 respectively. The fate ofthe remaining taken by nine patients and 10 patients were four patients are unknown to us today (Table). taking no medicine at the time of the liver The mean time offollow up was 18 years (0-28). biopsy. Thus, because of the various medical treatments and the small group ofpatients, it was not meaningful to correlate the histological find- Results ings to the drugs taken. The liver function in all patients was evaluated LIVER BIOPSY INTERPRETATION by bilirubin, transaminases, alkaline phos- Among the 74 patients studied, 37 (50%) had a phatase, and Bromsulphalein retention tests. All completely normal initial liver biopsy. Twenty http://gut.bmj.com/ these tests were normal in all 74 patients. Liver three biopsies showed fatty infiltration, nine biopsy was performed on average seven years portal inflammation, and in five there were both after the onset of the ulcerative colitis. The fatty infiltration and portal inflammation. Three percutaneous technique was used and each displayed fatty infiltration sufficient to make the biopsy stained with haematoxylin-eosin and van diagnosis of fatty liver (more than 50% of the Gieson. The biopsies were reevaluated by one hepatocytes involved). One of these three liver pathologist and one hepatologist according patients was in clinical remission, whereas two on October 2, 2021 by guest. Protected copyright. to the classification system of liver diseases'4 and suffered from active colitis. In the liver biopsy without knowing the patients identity. Special from one patient in remission more extensive emphasis was placed on alterations in the portal portal inflammation was seen. tracts such as inflammation and fibrosis. Hepato- The quantitative data regarding portal inflam- cellular degeneration and fatty infiltration were mation and lobular changes in relation to the also carefully assessed. Portal inflammation and inflammatory activity of the colitis are given in fatty infiltration were subjectively quantified on Figures 1 and 2, respectively, where it can be an arbitary scale from 0 to + + + +. seen that there was no correlation between the Through The National Population Registry it was possible to trace 68 patients. The time of 100, follow up was taken for 60 patients as the last recorded hospital visit when a clinical examina- tion was carried out with measurements of * 80 transaminases, alkaline phosphatase and bili- 0. rubin. Biochemical data of the liver function [jI Remission7 .
Load more

Recommended publications
  • Septicaemia After Colonoscopy in Patients With
    450 Gut, 1991,32,450-451 Septicaemia after colonoscopy in patients with cirrhosis Gut: first published as 10.1136/gut.32.4.450 on 1 April 1991. Downloaded from j R Thornton, M S Losowsky Abstract PATIENT 2 Two patients with ulcerative colitis and In 1987, a 34 year old man underwent routine chronic active hepatitis with cirrhosis, who colonoscopy because ofhis ulcerative colitis of 12 developed Gram negative septicaemia after years' duration. Twenty three years earlier a colonoscopy are described. These and two liver biopsy had shown that he had chronic similar reported cases indicate that giving active hepatitis and cirrhosis. Hepatitis B prophylactic antibiotics to patients with cir- markers were negative. In 1983 he developed rhosis undergoing colonoscopy should be con- ascites and had remained on spironolactone since sidered, particularly when the cirrhosis is then. advanced. At the time ofhis colonoscopy he claimed that he felt reasonably well and was continuing to work. However, he had a moderate amount of Prophylactic antibiotics have been advised for ascites. His medication was: prednisolone 5 mg patients undergoing colonoscopy who have daily, spironolactone 200 mg daily, and sul- valvular heart disease, cardiac prostheses, severe phasalazine 1 g twice daily. Preoperative blood immunodepression, or hepatic cirrhosis with tests were: bilirubin 53 ,umol/1, alanine amino- ascites.' The last of these recommendations is transferase 38 IU/, alkaline phosphatase 206 IU/ based on a single case report in which it was not 1, albumin 28 g/l, prothrombin time 16 seconds certain that colonoscopy was responsible for the (control 14 seconds). infection, as hepatic angiography was performed After bowel preparation with three litres of the day before peritonitis developed.' We were Golytely, colonoscopy to the caecum was per- unaware of this case but our recent experience formed.
    [Show full text]
  • Ultra-Sound Guided Liver Biopsy
    Ultra-Sound Guided Liver Biopsy What is a liver biopsy? A liver biopsy is a procedure used for making the diagnosis of abnormal liver conditions. A small piece of liver tissue is removed using a special needle for examination under a microscope. The liver tissue allows the doctor to see if your liver is healthy or to better understand why you have liver damage or disease and how severe any damage is. The most common method of liver biopsy is percutaneously (“through the skin”). This procedure is often performed as an outpatient and does not routinely require hospital admission. A qualified gastroenterologist does the liver biopsy. This is a doctor who specializes in diseases of the digestive system and liver. Does the liver biopsy hurt? You may feel minor discomfort during the biopsy. Some people do have some discomfort at the site of the biopsy for the first 24 to 48 hours after the procedure but this is often relieved by simple painkillers such as Tylenol. Why do I need a liver biopsy? Your doctor will have discussed this with you or written to you about the need for a liver biopsy. If you have any questions, please ask. This test may be carried out for a number of reasons. Common indications include: Your symptoms, blood tests and scans (ultrasound, CT or MRI scans) suggest you have liver disease. However, sometimes it is not possible to tell what the cause is on the basis of these tests alone. There appears to be a lump in your liver which has been seen on previous scans and a sample of tissue is needed to identify what it is.
    [Show full text]
  • AASLD Position Paper : Liver Biopsy
    AASLD POSITION PAPER Liver Biopsy Don C. Rockey,1 Stephen H. Caldwell,2 Zachary D. Goodman,3 Rendon C. Nelson,4 and Alastair D. Smith5 This position paper has been approved by the AASLD and College of Cardiology and the American Heart Associa- represents the position of the association. tion Practice Guidelines3).4 Introduction Preamble Histological assessment of the liver, and thus, liver bi- These recommendations provide a data-supported ap- opsy, is a cornerstone in the evaluation and management proach. They are based on the following: (1) formal re- of patients with liver disease and has long been considered view and analysis of the recently published world to be an integral component of the clinician’s diagnostic literature on the topic; (2) American College of Physi- armamentarium. Although sensitive and relatively accu- cians Manual for Assessing Health Practices and De- rate blood tests used to detect and diagnose liver disease signing Practice Guidelines1; (3) guideline policies, have now become widely available, it is likely that liver including the AASLD Policy on the Development and biopsy will remain a valuable diagnostic tool. Although Use of Practice Guidelines and the American Gastro- histological evaluation of the liver has become important enterological Association Policy Statement on Guide- in assessing prognosis and in tailoring treatment, nonin- lines2; and (4) the experience of the authors in the vasive techniques (i.e., imaging, blood tests) may replace specified topic. use of liver histology in this setting, particularly with re- Intended for use by physicians, these recommenda- gard to assessment of the severity of liver fibrosis.5,6 Sev- tions suggest preferred approaches to the diagnostic, ther- eral techniques may be used to obtain liver tissue; a table apeutic, and preventive aspects of care.
    [Show full text]
  • Detailed Categories 2016-Update
    KNHSS Kuwait National Healthcare-associated Infections Surveillance System 5. Bile duct, liver or pancreatic surgery Excision of bile ducts or operative procedures on the biliary tract, liver or pancreas (does not include operations only on gallbladder) 50.0 Hepatotomy Incision of abscess of liver Removal of gallstones from liver Stromeyer-Little operation 50.12 Open biopsy of liver Wedge biopsy 50.14 Laparoscopic liver biopsy Excludes: Closed (percutaneous)[needle] biopsy of liver (50.11) Transjugular liver biopsy (50.13) 50.21 Marsupialization of lesion of liver 50.22 Partial hepatectomy Wedge resection of liver Excludes: Closed (percutaneous)[needle] biopsy of liver (50.11) 50.23 Open ablation of liver lesion or tissue 50.25 Laparoscopic ablation of liver lesion or tissue 50.26 Other and unspecified ablation of liver lesion or tissue 50.29 Other destruction of lesion of liver Cauterization of hepatic lesion Enucleation of hepatic lesion Evacuation of hepatic lesion Excludes: Percutaneous ablation of liver lesion or tissue (50.24) Percutaneous aspiration of lesion (50.91) Laser interstitial thermal therapy [LITT] of lesion or tissue of liver under guidance(17.63) 1 KNHSS Kuwait National Healthcare-associated Infections Surveillance System 50.3 Lobectomy of liver 50.4 Total hepatectomy 50.61 Closure of laceration of liver 50.69 Other repair of liver Hepatopexy 51.31 Anastomosis of gallbladder to hepatic ducts 51.32 Anastomosis of gallbladder to intestine 51.33 Anastomosis of gallbladder to pancreas 51.34 Anastomosis of
    [Show full text]
  • Liver Biopsy
    William F. Erber, M.D., P.C. Gastroenterology and Endoscopy Diseases of the Digestive Tract, Liver and Pancreas Board Certified William F. Erber, M.D., F.A.C.P., F.A.C.G., A.G.A.F. 591 Ocean Parkway Jonathan A. Erber, M.D. Brooklyn, N.Y. 11218 Tel (718) 972-8500 Fax (718) 972-0064 www.drerber.com Liver Biopsy In a liver biopsy (BYE-op-see), the physician examines a small piece of tissue from your liver for signs of damage or disease. A special needle is used to remove the tissue from the liver. The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. An x ray could suggest that the liver is swollen. Looking at liver tissue itself is the best way to determine whether the liver is healthy or what is causing it to be damaged. Preparation Before scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. Be sure to mention any medications you take, especially those that affect blood clotting, like blood thinners. One week before the procedure, you will have to stop taking aspirin, ibuprofen, and anticoagulants. The digestive system You must not eat or drink anything for 8 hours before the biopsy, and you should plan to arrive at the hospital about an hour before the scheduled time of the procedure. Your physician will tell you whether to take your regular medications during the fasting period and may give you other special instructions.
    [Show full text]
  • Ultrasound-Guided Percutaneous Core Needle Biopsy of Abdominal
    Original Article | Experimental and Others Pictorial Essay | Gastrointestinal Imaging https://doi.org/10.3348/kjr.2017.18.2.309 pISSN 1229-6929 · eISSN 2005-8330 Korean J Radiol 2017;18(2):309-322 Ultrasound-Guided Percutaneous Core Needle Biopsy of Abdominal Viscera: Tips to Ensure Safe and Effective Biopsy Jin Woong Kim, MD1, Sang Soo Shin, MD1, 2 1Department of Radiology, 2Center for Aging and Geriatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea Ultrasound-guided percutaneous core needle biopsy (USPCB) is used extensively in daily clinical practice for the pathologic confirmation of both focal and diffuse diseases of the abdominal viscera. As a guidance tool, US has a number of clear advantages over computerized tomography or magnetic resonance imaging: fewer false-negative biopsies, lack of ionizing radiation, portability, relatively short procedure time, real-time intra-procedural visualization of the biopsy needle, ability to guide the procedure in almost any anatomic plane, and relatively lower cost. Notably, USPCB is widely used to retrieve tissue specimens in cases of hepatic lesions. However, general radiologists, particularly beginners, find USPCB difficult to perform in abdominal organs other than the liver; indeed, a full understanding of the entire USPCB process and specific considerations for specific abdominal organs is necessary to safely obtain adequate specimens. In this review, we discuss some points and techniques that need to be borne in mind to increase the chances of successful USPCB. We believe that the tips and considerations presented in this review will help radiologists perform USPCB to successfully retrieve target tissue from different organs with minimal complications.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Development of the ICD-10 Procedure Coding System (ICD-10-PCS)
    Development of the ICD-10 Procedure Coding System (ICD-10-PCS) Richard F. Averill, M.S., Robert L. Mullin, M.D., Barbara A. Steinbeck, RHIT, Norbert I. Goldfield, M.D, Thelma M. Grant, RHIA, Rhonda R. Butler, CCS, CCS-P The International Classification of Diseases 10th Revision Procedure Coding System (ICD-10-PCS) has been developed as a replacement for Volume 3 of the International Classification of Diseases 9th Revision (ICD-9-CM). The development of ICD-10-PCS was funded by the U.S. Centers for Medicare and Medicaid Services (CMS).1 ICD-10- PCS has a multiaxial seven character alphanumeric code structure that provides a unique code for all substantially different procedures, and allows new procedures to be easily incorporated as new codes. ICD10-PCS was under development for over five years. The initial draft was formally tested and evaluated by an independent contractor; the final version was released in the Spring of 1998, with annual updates since the final release. The design, development and testing of ICD-10-PCS are discussed. Introduction Volume 3 of the International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) has been used in the U.S. for the reporting of inpatient pro- cedures since 1979. The structure of Volume 3 of ICD-9-CM has not allowed new procedures associated with rapidly changing technology to be effectively incorporated as new codes. As a result, in 1992 the U.S. Centers for Medicare and Medicaid Services (CMS) funded a project to design a replacement for Volume 3 of ICD-9-CM.
    [Show full text]
  • Percutaneous Or Transjugular Liver Biopsy
    UW MEDICINE | PATIENT EDUCATION | | Angiography: Percutaneous or | Transjugular Liver Biopsy | How to prepare and what to expect This handout explains how to prepare and what to expect when having a percutaneous or transjugular liver biopsy What is a liver biopsy? During a liver biopsy, your doctor takes a small sample of tissue from your liver. This tissue is studied and tested in the lab. Why do I need a liver biopsy? Your provider will check the option below that applies to you. Your blood tests show that you may have chronic liver disease. A liver biopsy will tell your doctors more about this disease and how much damage has been done to your liver. DRAFT As a liver transplant patient, you will have regular liver biopsies. The biopsy is one of your regular screening tests. It will help your doctors see if rejection is present or find the cause of abnormal liver tests. How is a liver biopsy done? A sample of liver tissue can be taken either through the skin (percutaneous) or through a jugular vein (transjugular). Jugular veins are large veins in the neck that move blood from the head, brain, face, and neck back toward the heart. Percutaneous Liver Biopsy A percutaneous biopsy is the most common way to get a sample of liver tissue. An ultrasound of your upper abdomen is done to find the best place to do this biopsy. During the procedure: This X-ray was taken during a transjugular liver biopsy. It shows • Your doctor will use ultrasound the catheter (dark line) entering the to guide the catheter to your liver.
    [Show full text]
  • Review Article Application of Percutaneous Liver Biopsy in Living Donor Liver Transplantation
    Int J Clin Exp Med 2018;11(10):10372-10379 www.ijcem.com /ISSN:1940-5901/IJCEM0075559 Review Article Application of percutaneous liver biopsy in living donor liver transplantation King-Wah Chiu1, Hock-Liew Eng2, Yu-Fan Cheng3, Bruno Jawan4, Chao-Long Chen5 1Division of Hepato-Gastroenterology, Department of Internal Medicine, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taiwan; Departments of 2Pathology, 3Diagnostic Radiology, 4Anesthesia, 5Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taiwan Received March 6, 2018; Accepted July 13, 2018; Epub October 15, 2018; Published October 30, 2018 Abstract: Percutaneous liver biopsy (PLB) is one of the most important procedures to obtain tissue for assessment of the liver’s condition, both for potential donor evaluation and for graft pathological identification in living donor liver transplantation (LDLT). To describe a skillful technique with different situations on LDLT, a series of PLB proce- dures was developed as a teaching program from clinic to the bench since 1988 to 2012. A total of 2054 episodes of PLB were reviewed in the current series including potential donor evaluation in 8.3% (169), selected liver biopsy in 77.2% (1586), dual graft biopsy in 1.2% (26), pediatric liver biopsy in 8.8% (181), difficult biopsy in 4.2% (87), and intra-abdominal biopsy in 0.24% (5). For infant and pediatric recipients, intravenous general anesthesia or sedation was necessary. The acute rejection rate was 15%, which included 64.6% in mild and 35.4% in moderate degree. The overall complication rate was 0.097%.
    [Show full text]
  • Liver Biopsy
    Liver Biopsy National Digestive Diseases Information Clearinghouse What is a liver biopsy? A liver biopsy is a procedure that involves taking a small piece of liver tissue for examination with a microscope for signs of damage or disease. The three types of liver biopsy are the following: • Percutaneous biopsy—the most common type of liver biopsy—involves inserting Liver a hollow needle through the abdomen into the liver. The abdomen is the area between the chest and hips. • Transvenous biopsy involves making a small incision in the neck and inserting a needle through a hollow tube called a sheath through the jugular vein to the liver. • Laparoscopic biopsy involves inserting a laparoscope, a thin tube with a tiny The liver, the body’s largest internal organ, has many video camera attached, through a small important functions. incision to look inside the body to view the surface of organs. The health care provider will insert a needle through absorbed into the blood. The liver has many a plastic, tubelike instrument called functions, including a cannula to remove the liver tissue • taking up, storing, and processing sample. nutrients from food—including fat, sugar, and protein—and delivering them What is the liver and what to the rest of the body when needed does it do? • making new proteins, such as clotting The liver is the body’s largest internal organ. factors and immune factors The liver is called the body’s metabolic • producing bile, which helps the body factory because of the important role it absorb fats, cholesterol, and fat-soluble plays in metabolism—the way cells change vitamins food into energy after food is digested and • removing waste products the kidneys • asthma medications cannot remove, such as fats, cholesterol, • blood pressure medications toxins, and medications • blood thinners A healthy liver is necessary for survival.
    [Show full text]
  • ITPE Sample.Fm
    Chapter 2: Introduction to ICD-10-PCS STRUCTURE AND COMPONENTS OBJECTIVES This chapter will provide an overview of the structure of ICD-10-PCS and how In this chapter you will learn: its components make up each code. In addition, the PCS coding conventions contained in the official ICD-10-PCS Coding Guidelines will be discussed. The • The basic structure of each ICD-10-PCS code complete set of official guidelines may be found in appendix A at the end of this • The general definition of each of book. the seven PCS characters • About the three components of The ICD-10-PCS system is a completely different type of coding system than PCS (Index, Tables, List of Codes) many coding professionals may be familiar with. Instead of looking up codes in • The structure of the PCS tables the index and verifying a fixed code in the tabular list that most likely matches from which codes are constructed the documentation in medical record, PCS codes are constructed from • How to use the alphabetic index component parts found in tables. Every PCS code is made up of seven to initiate code construction characters, and each character represents a distinct value. An alphabetic index is used to direct the coder to a specific PCS table, where the remaining code values are selected. By utilizing a table format, exponentially more codes may be constructed in PCS than were available in ICD-9-CM volume 3. Compared to the current “look-up” process for ICD-9-CM, coding in ICD-10-PCS requires a process of combining semi-independent values from among a selection of values, according to the rules governing the construction of codes.
    [Show full text]