scholarly journals Serotonin Syndrome in a Patient on Trazodone and Duloxetine Who Received Fentanyl following a Percutaneous Liver Biopsy

2015 ◽  
Vol 9 (2) ◽  
pp. 132-136 ◽  
Author(s):  
Ryan R. Gaffney ◽  
Ian R. Schreibman
Keyword(s):  
Liver Biopsy ◽  
Serotonin Syndrome ◽  
Signs And Symptoms ◽  
Percutaneous Liver Biopsy ◽  
Increased Risk ◽  
Life Threatening ◽  
Sedation And Analgesia ◽  
Missed Diagnosis ◽  
Liver Biopsies ◽  
Medical Intensive Care

Serotonin syndrome is a rare but potentially life-threatening adverse drug reaction resulting from the use or overuse of serotonergic medications alone or in combination. Mild symptoms, overlapping features with similar conditions and clinician lack of awareness are the major reasons for an often missed diagnosis. Not surprisingly, this condition is significantly underreported as a potential complication of endoscopy if serotonergic medications are used periprocedurally for sedation and analgesia. Here we report the case of a patient with relapsed chronic hepatitis C on antidepressant medications who developed signs and symptoms of serotonin syndrome after a percutaneous liver biopsy. Review of the patient's medication list suggested a possible interaction between her home antidepressants and the post-procedure use of fentanyl for abdominal pain. The patient required monitoring in the medical intensive care unit and stabilized after the administration of benzodiazepines and temporary discontinuation of her home medications. We propose that clinicians need to be aware of the increased risk of serotonin syndrome in the outpatient endoscopy setting, particularly with the wider use of serotonergic antidepressants now available and the repeated number of liver biopsies being performed for management of patients with chronic liver disease.

scholarly journals Acute Pancreatitis Secondary to Hemobilia after Percutaneous Liver Biopsy: A Rare Complication of a Common Procedure, Presenting in an Atypical Fashion

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Ramy Mansour ◽  
Justin Miller
Keyword(s):  
Acute Pancreatitis ◽  
Liver Biopsy ◽  
Rare Complication ◽  
Signs And Symptoms ◽  
Transcatheter Embolization ◽  
Percutaneous Liver Biopsy ◽  
Imaging Studies ◽  
Common Procedure ◽  
Elevated Alkaline Phosphatase ◽  
Negative Imaging

Percutaneous Liver Biopsy is an often-required procedure for the evaluation of multiple liver diseases. The complications are rare but well reported. Here we present a case of a 60-year-old overweight female who underwent liver biopsy for elevated alkaline phosphatase. She developed acute pancreatitis secondary to hemobilia, with atypical signs and symptoms, following the biopsy. She never had the classic triad of RUQ pain, jaundice, and upper GI hemorrhage. There were also multiple negative imaging studies, thus complicating the presentation. She was successfully treated with ERCP, sphincterotomy, balloon sweep, and stent placement. Angiography and transcatheter embolization were not required.

scholarly journals Percutaneous Liver Biopsy Practice Patterns Among Canadian Hepatologists

2013 ◽  
Vol 27 (11) ◽  
pp. e31-e34 ◽  
Author(s):  
Mohammed Aljawad ◽  
Eric M Yoshida ◽  
Julia Uhanova ◽  
Paul Marotta ◽  
Natasha Chandok
Keyword(s):  
Liver Biopsy ◽  
Patient Preference ◽  
Practice Patterns ◽  
Standard Procedure ◽  
Percutaneous Liver Biopsy ◽  
Equal Frequency ◽  
The Past ◽  
Perception Of Safety ◽  
Liver Biopsies ◽  
Ambulatory Procedure

BACKGROUND: Percutaneous liver biopsy (PLB) is the standard procedure to obtain histological samples essential for the management of various liver diseases. While safe, many hepatologists no longer perform their own PLBs; the reasons for this practice shift are unknown.OBJECTIVE: To describe the attitudes, practice patterns and barriers to PLB among hepatologists in Canada.METHODS: A survey was distributed to all hepatologists in Canada.RESULTS: Thirty-two of 40 (80%) hepatologists completed the survey; the majority of respondents were male (72%) and had been in practice for >5 years in an academic setting. Fifty-six per cent of hepatologists referred all PLBs to radiology, and only 19% of hepatologists reported performing their own PLBs most or all of the time. There were no sex differences nor were there differences based on years in practice. Fifty per cent of respondents who performed PLB routinely used ultrasound, and PLBs are performed in equal frequency in an ambulatory procedure area (50%) versus the endoscopy suite (36%). For almost one-half of hepatologists (47%), their performance of PLBs decreased in the past five years. The majority of respondents at an academic centre (75%) reported access to FibroScan (Echosens, France), and most estimated a resultant 25% to 50% reduction in the need for PLBs. Lack of resources, patient preference and suboptimal reimbursement were the most common reasons cited for not performing PLBs.CONCLUSION: Most hepatologists in Canada do not perform PLBs to the extent that they did in the past, but refer to radiology. The reasons for this shift in practice include lack of resources, improved perception of safety and patient preference. Where available, FibroScan resulted in a perceived 25% to 50% reduction in required liver biopsies.

scholarly journals Value and risk of percutaneous liver biopsy in patients with cirrhosis and clinical suspicion of autoimmune hepatitis

2021 ◽  
Vol 8 (1) ◽  
pp. e000701
Author(s):  
Pimsiri Sripongpun ◽  
Ananya Pongpaibul ◽  
Phunchai Charatcharoenwitthaya
Keyword(s):  
Liver Biopsy ◽  
Autoimmune Hepatitis ◽  
Significant Risk ◽  
Clinical Information ◽  
Diagnostic Information ◽  
Overlap Syndrome ◽  
Clinical Suspicion ◽  
Primary Biliary Cholangitis ◽  
Percutaneous Liver Biopsy ◽  
Liver Biopsies

ObjectiveThe decision regarding whether to perform a liver biopsy in patients with cirrhosis and clinically suspected autoimmune hepatitis (AIH) remains a challenge. This study aimed to assess the utility and complications of percutaneous liver biopsy in cirrhosis for differentiating AIH from other liver conditions.MethodsA clinicopathological database of patients undergoing percutaneous liver biopsies for suspected AIH (unexplained hepatitis with elevated γ-globulin and autoantibody seropositivity) was reviewed to identify patients presenting with cirrhosis. Biopsy slides were reviewed by an experienced hepatopathologist who was blinded to clinical data.ResultsIn 207 patients who underwent liver biopsy for suspected AIH, 59 patients (mean age: 59.0±12.0 years, 83.1% female) had clinically diagnosis of cirrhosis. Mean Child-Turcotte-Pugh score was 6.6±1.6, and 44% of patients had a Child-Turcotte-Pugh score≥7. According to the revised International AIH Group (IAIHG) criteria, histology assessment combined with clinical information facilitated a diagnosis of AIH or overlap syndrome of AIH and primary biliary cholangitis (PBC) in 81.4% of cases. Liver biopsy identified other aetiologies, including PBC (n=2), non-alcoholic steatohepatitis (n=6) and cryptogenic cirrhosis (n=3). A reliable diagnosis of AIH could be made using histological category of the simplified criteria in 69.2% and 81.8% of cases using IAIHG scores before biopsy of <10 and 10–15, respectively. Three patients with cirrhosis (5.1%) experienced bleeding following biopsy, but none of 148 patients with non-cirrhosis had bleeding complication (p=0.022).ConclusionLiver biopsy provides important diagnostic information for the management of patients with cirrhosis and suspected AIH, but the procedure is associated with significant risk.

scholarly journals Complications and Efficiency of Liver Biopsies using the Tru-Cut Biopsy Gun

2009 ◽  
Vol 4 (02) ◽  
pp. 091-095 ◽  
Author(s):  
Figen Caglan Cevik ◽  
Nevil Aykin ◽  
Hasan Naz
Keyword(s):  
Liver Biopsy ◽  
Chronic Viral Hepatitis ◽  
Percutaneous Liver Biopsy ◽  
Ultrasound Guided ◽  
Biopsy Site ◽  
Major Complications ◽  
Significant Difference ◽  
Liver Biopsies ◽  
Liver Bleeding

Objectives: The study aimed to evaluate the complications and quality of the specimens of percutaneous liver biopsy in patients with chronic viral hepatitis who were scheduled for treatment and also to evaluate the contribution of the knowledge of ultrasound guided (USG) biopsy localization to the existing data. Methodology: Liver biopsies conducted at our clinic between 2003 and 2008 were retrospectively evaluated. In 53.8% of the cases, hepatobiliary USG was performed to mark the localization of the biopsy site. An automatically triggered Tru-Cut biopsy gun was used. Results: Biopsies waere taken from the livers of 236 patients (46.6% male, 53.4% female) with a mean age of 47.1 ± 12.5 years. The majority of patients had hepatitis C (61.9%); 1.6% experienced major complications (3 patient biliary peritonitis, 1 patient liver bleeding); 52.1% of the samples were ≥ 1 cm in length; And 69.7% of the biopsy samples with specified portal area had ≥ 4 portal areas. There was no statistically significant difference between the  patients with localized and non-localized biopsy site in terms of major complications and length of biopsy samples ( respectively p = 1.000, p = 0.209 ). Conclusion: We believe that percutaneous liver biopsy using Tru-Cut biopsy gun can be peformed safely, with complications in 1.6% of the procedures. The length of the biopsy specimen is shorter than ideal values. Evaluation of the patients with and without USG-guided biopsy revealed no significant difference in terms of major complications and specimen size.

scholarly journals Blood Transfusion Requirements after Liver Biopsy

2000 ◽  
Vol 14 (10) ◽  
pp. 901-902
Author(s):  
Brian D O’Brien
Keyword(s):  
Blood Transfusion ◽  
Liver Biopsy ◽  
Tertiary Care ◽  
Fatal Outcome ◽  
Health Record ◽  
Percutaneous Liver Biopsy ◽  
Transfusion Requirements ◽  
Risk Patients ◽  
Liver Biopsies ◽  
Record Review

It is common practice to type and screen the blood before performing a percutaneous liver biopsy. Many practitioners think that this is unnecessary but do not have a reason to change their practice. The requirements for transfusion after biopsy were determined in a consecutive sample of cases at a tertiary care teaching hospital with the use of health record review and the anecdotal recall of gastroenterologists and others performing biopsies. One of 266 liver biopsies required a transfusion after biopsy over a two-year period. One other case of hemorrhage with a fatal outcome was recalled by several individuals. It is concluded that the incidence of significant hemorrhage after liver biopsy is low, and that it may not be necessary to type and screen the blood of low risk patients before biopsy.

A Case of Hemobilia Secondary to Percutaneous Liver Biopsy: The Clinical Course of Spontaneous Recovery and Changes of "Color Mosaic Appearance" on Color Doppler Sonogram

Choonpa Igaku ◽  
2006 ◽  
Vol 33 (6) ◽  
pp. 673-679
Author(s):  
Shuichi YAMAMOTO ◽  
Hitoshi MARUYAMA ◽  
Ayaka SEZA ◽  
Yoshio MASUYA ◽  
Toshio TUYUGUCHI ◽  
...  
Keyword(s):  
Liver Biopsy ◽  
Spontaneous Recovery ◽  
Clinical Course ◽  
Color Doppler ◽  
Percutaneous Liver Biopsy

Study of Biochemical and Clinical Markers in Steatohepatitis Related to Obesity

2018 ◽  
Vol 69 (6) ◽  
pp. 1501-1505
Author(s):  
Roxana Maria Livadariu ◽  
Radu Danila ◽  
Lidia Ionescu ◽  
Delia Ciobanu ◽  
Daniel Timofte
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Large Scale ◽  
Biological Data ◽  
Obese Patients ◽  
Clinical Markers ◽  
Mean Values ◽  
Nonalcoholic Fatty Liver ◽  
Obstructive Sleep ◽  
Increased Risk

Nonalcoholic fatty liver disease (NAFLD) is highly associated to obesity and comprises several liver diseases, from simple steatosis to steatohepatitis (NASH) with increased risk of developing progressive liver fibrosis, cirrhosis and hepatocellular carcinoma. Liver biopsy is the gold standard in diagnosing the disease, but it cannot be used in a large scale. The aim of the study was the assessment of some non-invasive clinical and biological markers in relation to the progressive forms of NAFLD. We performed a prospective study on 64 obese patients successively hospitalised for bariatric surgery in our Surgical Unit. Patients with history of alcohol consumption, chronic hepatitis B or C, other chronic liver disease or patients undergoing hepatotoxic drug use were excluded. All patients underwent liver biopsy during sleeve gastrectomy. NAFLD was present in 100% of the patients: hepatic steatosis (38%), NASH with the two forms: with fibrosis (31%) and without fibrosis (20%), cumulating 51%; 7 patients had NASH with vanished steatosis. NASH with fibrosis statistically correlated with metabolic syndrome (p = 0.036), DM II (p = 0.01) and obstructive sleep apnea (p = 0.02). Waist circumference was significantly higher in the steatohepatitis groups (both with and without fibrosis), each 10 cm increase increasing the risk of steatohepatitis (p = 0.007). The mean values of serum fibrinogen and CRP were significantly higher in patients having the progressive forms of NAFLD. Simple clinical and biological data available to the practitioner in medicine can be used to identify obese patients at high risk of NASH, aiming to direct them to specialized medical centers.

Adenocarcinoma of the Appendix in Elderly: Diagnostic dilemma

2020 ◽  
Vol 01 ◽  
Author(s):  
Heba Nofal ◽  
Hayder Al-Masari ◽  
Marwan Mohammed Rashed ◽  
Reham Ainawi ◽  
Desh Idnani ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Laparoscopic Appendectomy ◽  
Signs And Symptoms ◽  
Morbidity And Mortality ◽  
Diagnostic Dilemma ◽  
Increased Risk

: Acute appendicitis in elderly continue to be a diagnostic dilemma as it raises both the suspicion of malignancy and increased risk of morbidity and mortality. Cancers of the appendix are rare and most of them are found accidentally on appendectomies performed for acute appendicitis. When reviewed, majority of the tumors were carcinoid, adenoma, and lymphoma. Adenocarcinomas of appendix are only 0.08% of all cancers and the treatment remains controversial. This paper presents a case of 75-year-old female presented to emergency (ER) with signs and symptoms mimicking acute appendicitis, laparoscopic appendectomy was planned after a CT scan was done as it was suggesting acute appendicitis. The specimen then was sent foe pathology lab and a diagnosis of adenocarcinoma of the appendix was made.

The Relevance of Noninvasive Tools To Assess Fibrosis in Non-Alcoholic Fatty Liver Disease

2020 ◽  
Vol 26 (32) ◽  
pp. 3928-3938
Author(s):  
Grazia Pennisi ◽  
Ciro Celsa ◽  
Antonina Giammanco ◽  
Federica Spatola ◽  
Salvatore Petta
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Assessment Tools ◽  
Hepatic Decompensation ◽  
Alcoholic Fatty Liver ◽  
Simple Steatosis ◽  
Life Threatening ◽  
Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a growing cause of chronic liver diseases worldwide, involving about 25% of people. NAFLD incorporates a large spectrum of pathological conditions, from simple steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis and its complications include hepatic decompensation and hepatocellular carcinoma (HCC). This progression occurs, over many years, in an asymptomatic way, until advanced fibrosis appears. Thus, the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis are key issues. To date, the histological assessment of fibrosis with liver biopsy is the gold standard, but obviously, invasiveness is the greater threshold. In addition, rare but potentially life-threatening complications, poor acceptability, sampling variability and cost maybe restrict its use. Furthermore, due to the epidemic of NAFLD worldwide and several limitations of liver biopsy evaluation, noninvasive assessment tools to detect fibrosis in NAFLD patients are needed.

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