33 biopsia hepatica
TRANSCRIPT
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BIOPSIA HEPATICA
+METODO DIAGNOSTICO SIMPLE Y
SEGURO EN EL ESTUDIO DE ENFERMEDADES HEPATICAS
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BIOPSIA HEPATICA
TECNICAS
1.-A CIEGAS
Transtorácica.
2.-DIRIGIDA.
Laparoscópica, Ultrasonográfica y
Transyugular.
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BIOPSIA HEPATICA
INDICACIONES ABSOLUTAS.• Cirrosis alcohólica.• Hepatitis Crónica.• Cirrosis Biliar primaria.• Hepatitis Alcohólica• Hepatitis por Medicamentos.• Hepatitis Viral.• Hemocromatosis.
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BIOPSIA HEPATICA
Hepatitis
Autoinmune
Activa
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BIOPSIA HEPATICA
Cirrosis
Biliar
Primaria
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BIOPSIA HEPATICA
Hepatitis “B”
crónica
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BIOPSIA HEPATICA
Hepatitis “C”
crónica
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BIOPSIA HEPATICA
INDICACIONES RELATIVAS
• Alteraciones PFH.
• Fiebre de origen desconocido.
• Neoplasia Primaria o Metastásica
• Padecimientos congénitos
a).-Enf De Wilson.
b).-Def de antitripsina.
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BIOPSIA HEPATICA
Enfermedad
de
Wilson
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BIOPSIA HEPATICA
Deficiencia
de alfa 1
antitripsina
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BIOPSIA HEPATICA
CONTRAINDICACIONES ABSOLUTAS
• Alteraciones de la coagulación.
• Enfisema
• Quiste hidatídico.
• Infecciones locales.
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BIOPSIA HEPATICA
CONTRAINDICACIONES RELATIVAS
• No cooperador.
• Ausencia de Matidez Hepática.
• Ascitis.
• Colestasis extrahepática.
• Tumor vascularizado.
• Amiloidosis.
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BIOPSIA HEPATICA
COMPLICACIONES• Hemorragia.• Biliperitoneo.• Punción a órganos vecinos.• Lesión vascular.• Hemobilia• Hipotensión transitoria• Dolor, Fiebre y septicemia.• Fractura de la aguja• Derrame pleural.
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BIOPSIA HEPATICA
UTILIDAD
• Confirma diagnóstico clínico.
• Evalúa actividad necroinflamatoria.
• Evalúa fibrosis.
• Identifica enfermedades concomitantes.
• Evalúa respuesta terapeútica y proporciona estadio y pronóstico.
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BIOPSIA HEPATICA
Esteato
hepatitis
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BIOPSIA HEPATICA
Nódulos de
Regeneración
rodeados por
fibrina
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PARACENTESIS
• EXTRACCIÓN DEL LÍQUIDO LIBRE PRESENTE EN LA CAVIDAD ABDOMINAL(ascitis)
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PARACENTESIS
1. ESENCIAL EN EVALUACION DE ASCITIS
2. PUEDE SER
DIAGNOSTICA Y TERAPEUTICA
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PARACENTESIS
TECNICA
• Posición semifowler
• Región suprapúbica o cuadrantes inferiores
• Asepsia, anestesia y técnica en Z.
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PARACENTESIS
• Ascitis
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PARACENTESIS
CARACTERISTICAS DEL LIQUIDO
• Normal
• Turbio
• Lechoso
• Hemorrágico
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PARACENTESIS
PRUEBAS ORDINARIAS DEL LIQUIDO
• CITOQUIMICO
• CITOLOGICO
• CULTIVO
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PARACENTESIS
PRUEBAS SECUNDARIAS DEL LIQUIDO
• Tinción de Gram
• Tinción de Barr
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PARACENTESIS
• TERAPEUTICA
• En ascitis refractaria.
• En insuficiencia respiratoria
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PARACENTESIS
• Se recomienda reposición con albúmina
IV, a 8grs por litro extraído para prevenir
disfunción circulatoria.
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PARACENTESIS
ComplicaciónSangradoPost-punción
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PARACENTESIS
TécnicaLaparoscópica
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PARACENTESIS
Sitios depunción
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PARACENTESIS
Ascitis aTensión:sitios depunción
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Classification of ascitic fluid
• infection Type PMN count (cells/mm3) Bacterial culture result Spontaneous bacterial peritonitis >250 Positive (one organism) Culture-negative neutrocytic bacterascites >250 Negative Monomicrobial nonneutrocytic bacterascites <250 Positive (one organism) Polymicrobial bacterascites <250 Positive (polymicrobial) Secondary bacterial peritonitis >250 Positive (polymicrobial) PMN, polymorphonuclear neutrophil leukocyte.