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(move blood work to medical liver from 'liver') |
(mv from 'liver pathology') |
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Line 91: | Line 91: | ||
*Normal = 1-4 mmHg. | *Normal = 1-4 mmHg. | ||
**Elevated in [[portal hypertension]]. | **Elevated in [[portal hypertension]]. | ||
=Liver biopsy= | |||
==Medical liver biopsy adequacy== | |||
Liver biopsy specimens should be:<ref>{{Ref MacSween|418}}</ref> | |||
*2.0 cm in length and contain 11-15 portal tracts, | |||
*The core should be deeper than 1.0 cm from the liver capsule; specimens close to the capsule may lead to over grading of fibrosis. | |||
==Reporting== | |||
{{Main|Pathology reports}} | |||
<pre> | |||
Specimen, procedure: | |||
- Diagnosis. | |||
</pre> | |||
The diagnosis usually contains grading and staging information, e.g. ''activity 2 /4, Laennec fibrosis stage 1 /4''. | |||
In the context of medical liver disease: | |||
*Grade = inflammation/activity. | |||
*Stage = severity of fibrosis/architectural changes. | |||
Notes: | |||
*The term "acute" is infrequently used in liver pathology. | |||
*In the liver: neutrophils ''is not'' acute -- unlike most elsewhere in the body.<ref>OA. September 2009.</ref> | |||
===A microscopic checklist=== | |||
<pre> | |||
Size of biopsy: Adequate | |||
Fragmentation: Absent | |||
Fibrosis: Stage 2-3/4, mostly stage 2 | |||
Fibrous septa: Present | |||
Septa with curved contours: Present – focally only | |||
Large droplet steatosis (% of hepatocytes): Present, moderate 60% | |||
Ballooning of hepatocytes: Present, rare | |||
Mallory-Denk bodies: Present, rare | |||
Portal inflammation: Present | |||
Interface activity: Minimal (0-1/4) | |||
Lobular necroinflammation: Minimal | |||
Ducts: Present in normal numbers | |||
Duct injury: Absent | |||
Ductular reaction: Absent | |||
Cholestasis: Absent | |||
Terminal hepatic venules: Present | |||
Iron stain: Absent | |||
Ground glass cells with routine stains: Absent | |||
PASD for alpha-1 antitrypsin droplets: Negative | |||
</pre> | |||
=Viral hepatitis= | =Viral hepatitis= |
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