KINESIOL 1Y03 Chapter Notes - Chapter 13: Portal Hypertension, Portal Vein, Ascites
22 Jun 2018
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Fibroscan demonstration
Why do we need to diagnose fibrosis?
To diagnose cirrhosis to intiate surveillance for complications: HCC and
oesophageal varix surveillance
To prioritize / assign treatment e.g. in Hep C if fibrosis not advanced may defer
treatment until IFN-free treatments available
To motivate/reassure the patient
To provide prognostic information e.g. to inform management of co-morbidities
To develop new technologies
Staging of fibrosis:
METAVIR = 0-6
ISHAK = 0-4
1) enlarged portal tract but no septa (fibrous strands)
2) enlarged portal tract with few septa
3) numerous septa evident
4) cirrhosis
Biopsy provides info on inflammation (necro-inflammation or grading), steatosis,
infiltration/granuloma and other pathological findings e.g. alpha-1-antitrypsin using specific
stains
80% accuracy according to post-mortem studies – Afdhal N, Hepatology 2006
X- sampling variation (only small sample created)
X- intra and inter-observer variation (interobserver variability: 10% of biopsies differ by two
histopathologists – Regev et al, Am J Gastro 2002)
X- 2-dimensional view
X- semi-quantitative categorical approximation of a continous process – Standish et al Gut
2006
Complications:
X- minor (3-305) = pain, haematoma
X- major (0.3-0.6%) = pneumothorax, sepsis, perforation of a viscus, major intraperitoneal
haemorrhage
X- Death (0-0.03)
although risks LOW, they compound when patients need multiple biopsies
Fibroscan
Ziol M. et al. 2005. Hepatology: USS transducer mounted along axis of a pulsing tip. Shear
waves (pulse) travel through the liver. Velocity is related to the elasticity of the liver;
stiffness is measured in kPa
Px lies in dorsal decubitus position with R arm in maximal abduction; operator
locates probe to a liver portion >6cm thick and free of vascular
structures/gallbladder
Takes a few minutes and is generally well-tolerated
To be valid, IQR must be <30% (low variability between samples), and success rate
must be >60%
Requires ten valid measures; success rate = number of valid measures / number of
total measures
Result is the median of the ten valid measures
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Document Summary
To diagnose cirrhosis to intiate surveillance for complications: hcc and oesophageal varix surveillance. To prioritize / assign treatment e. g. in hep c if fibrosis not advanced may defer treatment until ifn-free treatments available. To provide prognostic information e. g. to inform management of co-morbidities. Ishak = 0-4: enlarged portal tract but no septa (fibrous strands, enlarged portal tract with few septa, numerous septa evident, cirrhosis. Biopsy provides info on inflammation (necro-inflammation or grading), steatosis, infiltration/granuloma and other pathological findings e. g. alpha-1-antitrypsin using specific stains. 80% accuracy according to post-mortem studies afdhal n, hepatology 2006. X- intra and inter-observer variation (interobserver variability: 10% of biopsies differ by two histopathologists regev et al, am j gastro 2002) X- semi-quantitative categorical approximation of a continous process standish et al gut. X- major (0. 3-0. 6%) = pneumothorax, sepsis, perforation of a viscus, major intraperitoneal haemorrhage. Although risks low, they compound when patients need multiple biopsies.
