Cirrhosis laparoscopy

Orlando, R., Lirnssi, F., Okolicsanyi, L. Laparoscopy and liver biopsy further evidence that the two procedures improve the diagnosis of liver cirrhosis. A retrospective study of 1003 consecutive examinations. J. Chn. Gastroenterol. 1990 12 47—52... 

Fig. 11.2 Laparoscopy showing splenomegaly in portal hypertension due to liver cirrhosis...

Both the risks and the possibility of obtaining uncertain results are far greater with percutaneous biopsy than with laparoscopically directed biopsy. The latter produces a detailed diagnosis in 97-100% of cases, a result also confirmed by our own observations. (46, 90, 123, 129) Insufficient training in laparoscopy or the non-availability of this examination technique do not constitute an indication for percutaneous biopsy in liver cirrhosis, at least for initial diagnosis, (s. figs. 7.8, 7.15 16.5 28.13 35.2-35.4) (s. pp 160, 161, 408)... 

Protein degradation products may also trigger a febrile episode aetiological differentiation of the fever caused by such metabolic products is usually impossible. There are no effective therapeutic measures. Differential diagnosis of fever of unexplained origin (R.G. Petersdorf et af, 1961) can be very difficult in cirrhosis, a situation which presents an additional risk to the patient. In unexplained fever, laparoscopy is indicated, (s. tab. 7.10) (s. p. 156)... 

Laparoscopy The liver is enlarged and displays a dark reddish cyanotic surface with a rounded margin. Congested veins and collaterals in the abdominal region suggest portal hypertension. Transformational processes may occur in a chronic course (in 30-40% of cases) or when the liver is only partially affected, so that even the picture of a cirrhosis has been observed. Ascites, occasionally also in its sanguinolent form, is detected in most patients. 

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