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Gastrointestinal Endoscopy - part 10

Chế độ ăn uống có thể được nối lại trong vòng 2 giờ của sinh thiết. - Thuốc giảm đau như acetaminophen hoặc oxycodone cộng với acetaminophen có thể được đưa ra nếu cần thiết. - Bệnh nhân có thể không được sử dụng phòng tắm trong 6 h. - Thông báo cho bác sĩ theo yêu cầu nếu huyết áp | 232 Gastrointestinal Endoscopy Table 25.2. Common pathologic stains used to evaluate the liver Stain Usage Hematoxylin and eosin Perl s Prussian Blue Diastase PAS Trichrome Reticulin Orcein or Victoria blue stain Routine evaluation Iron Content Alphal antitrypsin deficiency Fibrosis Fibrosis Elastic fibers copper-associated protein Hepatitis B Rhodanine Congo Red Copper Amyloid 25 - Diet may be resumed within 2 h of the biopsy. - Analgesia such as acetaminophen or oxycodone plus acetaminophen can be given if needed. - Patient may not get up to use the bathroom for 6 h. - Notify physician on call if blood pressure 90 60 pulse 110 beats per minute or severe pain. - After 6 h patient may be discharged home. Laparoscopic liver biopsy - Technique - Obtain informed consent - Obtain intravenous access - Place in supine position - Premedicate with intramuscular meperidine - Abdomen draped and prepped in sterile fashion. - Intravenous meperidine and midazolam given for conscious sedation - An area of the abdominal wall approximately 2 cm above and 2 cm to the left of the umbilicus is anesthetized with 1 lidocaine without epinephrine. - Insert Veress needle and achieve pneumoperitoneum with either nitrous oxide or carbon dioxide. - Remove Veress needle. - Insert trocar into abdominal wall through Veress needle site and remove needle. - Insert laparoscope through trocar. - Place patient in reverse Trendelenburg position. - Perform visual exam with a laparoscope. - A biopsy needle is introduced through the abdominal wall under laparoscopic guidance and advanced to the liver in a tangential approach. - The needle is introduced into the liver and the biopsy is performed. - Insert second trocar through the abdominal wall to facilitate tamponade of biopsy site. Observe biopsy site until hemostasis occurs. - Remove both trocars with careful observation of sites for bleeding. - Suture puncture wounds after pneumperitoneum is allowed to drain. - Place bandage over puncture site - .