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Chapter 772

Liver biopsy is a dangerous procedure.However, Sun Lien believes that a biopsy is an essential item to truly diagnose Lu Chunyu's problem.

Due to the unique self-healing properties of the liver itself, unlike brain biopsy-liver biopsy rarely causes very serious sequelae or damage.

When examining Tang Min, Sun Lien and the doctors at the Fourth Central Hospital would try to avoid brain biopsy because of this.

But the liver is different.

Since the patient himself has jaundice, part of the content of the examination is consistent with autoimmune liver disease.There are also cysts of unknown nature.Then, it became a matter of course for doctors to choose biopsy to judge.

"The biopsy report hasn't come out yet, and Dr. Xu is staying in the pathology department to wait for the results." Sun Li'en and Dr. Pascal met Zhou Ce who had just returned not long ago in the office.He reported to the two superiors, "The pathology department initially determined that there is interface hepatitis."

This is a term that Sun Lien is relatively unfamiliar with, but the advantage of Chinese lies in this - even if it is only a term heard for the first time, most people can still understand the meaning it reflects more accurately.

The liver is not one piece of matter that is made of the same structure from the inside out.It, like many other organs, has different segments and layers.The "interface hepatitis" mentioned here is a term that describes the development of lesions to other levels.

Interestingly, interface hepatitis is not the only name.It may also be called "debrisy necrosis".But with recent research, doctors are increasingly using the term "interface hepatitis" to describe the loss of the hepatic boundary plate and adjacent liver cells in immune hepatitis.Therefore, the term "debris-like necrosis" has become much rarer.

No matter what this lesion is called, what it represents is very definite-abnormal apoptosis of cells in the liver.And this kind of lesion usually appears in chronic hepatitis.

Chronic hepatitis is a general term for a series of disease symptoms.It can be caused by many kinds of reasons.Includes viruses, bacteria, parasites, and autoimmune diseases, among others.Chronic refers to the course of the disease progressing for a longer period of time.

Judging from Lu Chunyu's self-indictment, she has developed jaundice since July last year.According to the relevant definition, if abnormal liver function occurs repeatedly and lasts for more than half a year, it can be identified as "chronic hepatitis".Therefore, the significance of the pathological detection of interface hepatitis is relatively clear - it is probably the cause of Lu Chunyu's jaundice.

There are four main causes of jaundice, the first is abnormal hemolysis, the second is abnormal liver cells, the third is cholestasis, and the fourth is congenital non-hemolytic jaundice.

Lu Chunyu was relatively old, his blood routine was normal on admission and he did not have viral hepatitis.Starting from these two points, congenital non-hemolytic jaundice and hemolytic jaundice can be excluded by comprehensive consideration.At the same time, the possibility of hepatocellular jaundice has also been greatly weakened.

"To find a disease that does not cause abnormal blood routine, but can extensively damage liver cells at the same time?" Sun Lien shook his head, simply ruling out the possibility of hepatocellular jaundice. "This possibility is very small."

"The possibility of cholestasis is relatively high... No, this is the only possibility." Zhou Ce nodded, and he thought so too. "The results of the MRCP examination applied for by the Department of Hepatobiliary Surgery can be seen on the system, but the degree of suspected thickening of the wall at the upper end of the common bile duct and pancreas is not very severe, and it does not feel like an obstruction."

"There is only one pathway for the production and transportation of bile. The liver cells secrete most of the bile, and a small part is secreted by the bile duct cells, and then the bile enters the gallbladder through the common bile duct for storage." Dr. Pascal muttered, "The common bile duct thickens, And she still has symptoms of chronic hepatitis... Isn't this just PBC?"

"Primary...biliary cirrhosis?" Sun Lien tried hard to recall for a long time before he remembered what PBC meant.He scratched his head, "I'm not very familiar with this."

"The symptoms match perfectly, and the test indicators match up." Dr. Pascal became more and more excited as he spoke. He waved his right hand at Sun Lien and said, "And the patient himself has AIH indicators, right?"

There is indeed evidence of the existence of AIH in Lu Chunyu's previous inspection report.Sun Li'en nodded, and then asked in confusion, "Aren't these two diseases?"

"Of course they are two diseases, but they are closely related diseases." Dr. Pascal glanced at Sun Lien, and then continued in an educational tone, "5~15% of patients with primary biliary cirrhosis at the same time Suffering from autoimmune hepatitis. It is not particularly rare for patients to suffer from two immune diseases at the same time, which is called 'overlap syndrome' in immunology." He winked at Sun Lien, "Such patients, You've seen it before."

Sun Li'en suddenly realized, isn't this the guy from the NGA forum?
The old man named Wang Ge was discharged from the hospital smoothly.And he suffered from two autoimmune diseases at the same time - systemic lupus erythematosus and Wegener's granulomatosis.However, Sun Lien made two separate diagnoses at that time, and he did not combine the two diseases into "overlap syndrome".

"According to our existing data, the possibility of this patient is AIH-PBC overlap syndrome is very high." Dr. Pascal sat on the stool and said confidently, "After the results of the pathology department come out, we can Got it—she should still have pathological changes of lymphocytic infiltration."

It has to be said that Dr. Pascale is indeed the highest-level immunology expert in the entire Fourth Central Hospital.His judgment was very accurate—the pathological test report reported 10 minutes later reads, “Hepatic cell edema, punctate necrosis and fragmented necrosis, more lymphocyte infiltration in the portal area, bile duct stasis, and early liver disease.” The formation of cirrhosis is consistent with the changes of viral hepatitis or autoimmune hepatitis. The results of immunohistochemistry and special staining: Glypican-3 (-), Hepatocyte (+), CD34 blood vessel (+), CK19 (bile duct +), Ki-67 ( scattered +), p53(-), CEA(-), CD10(-), PAS(-)."

"The next step is relatively simple—give her hormones..." Dr. Pascal was just halfway through his words, but he suddenly froze as if remembering something. After a while, he frowned and said, "This Does the patient have gastric varices?"

Sun Li'en nodded. The doctor from the Department of Hepatobiliary Surgery directly mentioned this situation when they went to the consultation.

"This is a bit troublesome." Dr. Pascal's brows furrowed deeper and deeper, "hormone therapy can improve blood biochemical indicators in a short period of time, but it takes at least three to six months to improve liver histology... But this treatment plan It is more likely to cause peptic ulcers. And the drug cannot be stopped casually - even if the drug is taken continuously for two years, the cases of relapse after stopping the drug are not uncommon."

This is where Dr. Pascal is in trouble.Fundic varices are themselves a consequence of cirrhosis leading to high portal pressure.Curved, swollen veins protrude from the fundus of the stomach, which greatly increases the risk of vein rupture and bleeding.

Bleeding from gastric varices is very dangerous.If gastric varices are also combined with peptic ulcer, the risk of massive bleeding faced by the patient will suddenly increase to an unacceptable level.

What's more, the use of hormones to treat AIH-PBC overlap syndrome cannot be stopped casually.According to Dr. Pascale, patients will likely need to take the drug for life.

If the varicose veins in the stomach fundus are not resolved, hormone therapy cannot be safely used.

"I can only be conservative first." There is no good way for everyone to deal with this dilemma.After a while, Sun Lien shook his head and said, "Let's go for liver protection treatment first. See if it can improve her cirrhosis of the liver - only if the cirrhosis of the liver is relieved, can it be possible to solve the varicose veins in the fundus of the stomach. Otherwise, even the hormones will not be available. Dare to use it for her."

　I... I'm too difficult... I feel like I'm doing a big problem of explaining medical terms, and I have to verify it after writing a few words...

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(End of this chapter)