Liver biopsy
In some situations, laboratory measurements do
not provide enough information about the etiology of a specific
liver disease. When there is an unexplained and persistent
elevation of LFTs, a liver biopsy may be needed to establish the
diagnosis and to provide prognostic information. An accurate
estimate of the amount of liver fibrosis, inflammation or necrosis can
only be made by liver biopsy.
In HCV infection, there is a poor correlation between symptoms or levels of alanine aminotransferase and histologic features of the liver. Thus, patients with HCV infection may have normal levels of liver enzymes and have significant fibrosis on biopsy. Conversely, patients may also have elevated serum ALT and trivial liver disease.•
Indications for liver biopsy include:
- Diagnosis
- Multiple parenchymal liver diseases
- Abnormal liver tests of unknown etiology
- Fever of unknown origin
- Focal or diffuse abnormalities on imaging studies
- Prognosis—Staging of known parenchymal liver disease
- Management—Developing treatment plans based on histologic analysis•
Contraindications to Percutaneous Liver Biopsy |
Absolute Contraindications |
- Uncooperative patient - requires positioning and breath holding
- Bleeding
- Prothrombin time 3-5 sec more than control
- Platelet count <50,000/mm3
- Prolonged bleeding time (10 minutes)
- Use of NSAID within previous 7-10 days
- Blood for Transfusion unavailable
- Infection of the hepatic bed
- Extrahepatic biliary obstruction
- Inability to identify an appropriate site for biopsy by percussion or ultrasonography
|
Relative Contraindications |
- Ascites
- Morbid obesity
- Possible vascular lesions
- Amyloidosis
- Hydatid disease
|
Complications of Percutaneous Liver Biopsy:
- Pain is the most common complication of percutaneous liver biopsy. Pain at
the biopsy site or referred pain radiating to the right shoulder due to
pressure on the liver capsule.
- Bleeding is the most important complication of percutaneous liver biopsy. Severe intraperitoneal bleeding may require hospitalization and transfusion. Chronic renal failure and congenital coagulopathies can increase the risk.
- Rare complications include: perforation of other organs, bile peritonitis, infection, neuralgia and death
Percutaneous biopsy procedure:•
- Patients must provide written informed consent
- Patients are placed flat in bed and the liver is localized in the right mid-axillary line
- Localization of the liver can be performed by percussion/palpation or by ultrasound
- Some physicians administer conscious sedation prior to the liver biopsy
- The skin over the biopsy site is cleaned with a suitable antiseptic, and lidocaine is injected locally to anesthetize the skin and the capsule of the liver
- Liver biopsy is performed by quickly inserting and then withdrawing a 15 to 18-gauge needle into the liver. A successful biopsy obtains a piece of liver tissue approximately the diameter of the lead in a pencil and 1 inch long
Post-procedure:•
- The patient lies on his/her right side for 1-2 hours and then on his/her back for 3-5 hours (total observation after liver biopsy is 4-6 hours)
- Blood pressure and heart rate are checked frequently during this time
- Patients are allowed to go home if they can follow instructions reliably and have easy access to a hospital should they develop bleeding or other complications
- Patients should remain off anti-coagulants, aspirin and NSAIDs for at least one week
- Patients should be advised to refrain from heavy lifting or strenuous exercise for one to two weeks following the procedur
Please visit this Web Path site to inspect a
normal liver biopsy specimen