Approaching a Liver Bx: An overview
Liver injury & the different patterns of injury. So it all boils down to figuring out whether the injury is portal based, lobular or vascular (here only central vein is being focusd in vascular). First it is very important to know the patient history and clinical information regarding LFT’s. This figure does not include all the entities just the common ones to think about.
Vascular causes: The first area in the liver to be affected by hypoxia is the central venous area due to the fact that it gets the least and the last supply of blood flow and thus oxygen. The vascular causes may range from ischemia to drugs (eosinophils are seen) to veno-occlusive disease or budd chair syndrome. This is just a very premature and basic categorization of liver injury based on the patterns of liver injury.
Lobular injury: The scope of which may begin from just piecemeal necrosis to geographic necrosis. The etiology can range from viral hepatitis to autoimmune hepatitis to fatty liver disease to even hepatocellular carcinoma.
Portal based injury: Primary sclerosing cholangitis/ primary biliary cirrhosis & secondary biliary cirrhosis where the inflammatory cells are restricted to the portal tracts and there is chewing up or destruction of the bile ducts. In some cases the bile ducts try to proliferate inorder to compensate & so there might be ductular proliferation.
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