Liver Biopsy in Children
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DIAGNOSTICS
Liver Biopsy in Children TEBYAN RABBANI, JOHANNA M ASCHER BARTLETT AND NAVEEN MITTAL From University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA Correspondence to: Dr Naveen Mittal, UT Health San Antonio, 7703 Floyd Curl Drive, MC-7816, San Antonio, TX 78229-3900, USA. [email protected] Liver biopsy is the cornerstone of medical decision-making for a wide range of hepatic diseases in children. The indications for liver biopsy vary greatly depending on the ease of diagnosis with non-invasive tests, the need to stage of disease, and the role of histological evaluation in management of liver disease. Multiple methods of liver biopsy are available to the clinician and are utilized based on clinical circumstances, cost, and consideration of contraindications. Collaboration between the clinician and pathologist is important in order to handle the tissue sample appropriately and interpret the histology. The purpose of this paper is to provide a broad overview of liver biopsy indications, techniques, pre- and post-biopsy care and complications, interpretations, contraindications, recent advancements, and pitfalls that occur with liver biopsies. Keywords: Chronic liver disease, Diagnosis, Histopathology, Management.
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cute and chronic liver diseases in children are multifactorial. Liver biopsy is considered the gold standard for diagnosis, prognosis, and assessment of treatment response for liver diseases. With the availability of ultrasound guidance and effective and safe sedation in children, it has become a routine procedure in many parts of the world. The purpose of this article is to provide an overview of the role of liver biopsy in children which includes its indications, overview of the most common techniques used, complications that may arise, handling of the tissue properly, interpretation of results, contraindications, recent advancements, and the pitfalls of liver biopsy.
capturing common but not all genetic and metabolic diseases. Neonatal cholestasis is caused by a wide range of etiologies and, some causes need urgent intervention before irreversible damage occurs. Biliary atresia needs urgent diagnosis as Kasai procedure, earlier in the neonatal period has a higher success rate [1]. A timely diagnosis of many metabolic disorders can be corrected by removal of the offending agent or providing corrective medication. Initial laboratory evaluation of neonatal cholestasis consists of a comprehensive metabolic panel, complete blood count with differential, gamma-glutamyl transferase (GGT), prothrombin time (PTT), international normalized ratio (INR), direct and total bilirubin [2]. Abdominal ultrasound and hepatobiliary scintigraphy are useful adjuncts in diagnosis. However, liver biopsy remains the diagnostic gold standard for diagnosis of neonatal cholestasis [3], especially biliary atresia, as imaging of the anatomical abnormalities of biliary passages is difficult to assess at a young age [4]. Liver biopsy has the highest sensitivity (100%) in detecting biliary atres
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