23- menghini's needle

this menghini 's needle is mainly used to do liver biopsies.

THE INDICATIONS OF LIVER BIOPSY ARE :

Liver biopsy, in combination with history and physical examination data, is a powerful clinical tool for diagnosing and treating liver disease. Indications for obtaining a biopsy specimen are listed in as follows. These are divided according to the type of clinical question framed.

• Evaluation of abnormal hepatic laboratory test results
• Confirmation of diagnosis and prognostication
• Suspected hepatic neoplasm
• Diagnosis of cholestatic liver disease
• Evaluation of infiltrative or granulomatous disease
• Following a case of liver transplantation to evaluate and manage rejection
• To evaluate unexplained jaundice or suspected drug reactions

The biopsy specimen may be used to identify or exclude possible etiologies for physical or laboratory abnormalities. Although various disease states may present similarly, diagnostic histologic patterns exist when used in the context of clinical presentation. For example, infiltration of the hepatic parenchyma by fat may exist in diseases due to alcohol abuse, hepatitis C, diabetes, and/or obesity. For each disease state, histologic clues exist that distinguish one from the other.

Liver biopsy plays little role in the determination of the organism responsible for systemic infection because blood cultures generally are revealing. The notable exceptions are intrahepatic tuberculosis and Mycobacterium avium complex (MAC).

Another indication for biopsy is the determination of the extent of histologic change present in a biopsy specimen. This involves scoring systems for the degrees of inflammation and fibrosis noted by the pathologist. Many systems exist for describing the microscopic findings, ranging from simplistic to complex. The majority of scoring systems report the degree of inflammation as the grade of the disease and the amount of fibrosis as the stage. An example here would be the finding of moderate inflammation (grade 3) in a specimen from a cirrhotic (stage 4) liver.

The third set of indications is the monitoring of the progression of disease or of treatment efficacy. For example, liver biopsy specimens frequently are used to evaluate and treat rejection following liver transplantation. Repeated biopsies are used less frequently to monitor progression of diseases such as primary biliary cirrhosis, chronic hepatitis C, or alcoholic liver disease.

Regardless of the indication for the biopsy, identifying which information the procedure is anticipated to yield is important.

CONTRAINDICATIONS OF LIVER BIOPSY ARE :

Contraindications to percutaneous liver biopsy are relatively few, but identifying contraindications is important to avoid the major complications associated with the procedure. Contraindications to liver biopsy include the following:

• Increased prothrombin time, international normalized ratio (INR) greater than 1.6
• Thrombocytopenia, platelet count less than 60,000
• Ascites (transjugular route preferred)
• Difficult body habitus (transjugular route preferred)
• Suspected hemangioma
• Suspected echinococcal infection
• Uncooperative patient

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