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liver biopsy
Indications:
1) abnormal liver function tests (without diagnosis)
a) cholestasis
b) steatosis
c) hepatitis
d) vanishing bile duct syndrome
e) hepatic cirrhosis
f) primary biliary cirrhosis
g) primary sclerosing cholangitis
2) hepatocellular carcinoma
3) hemochromatosis
4) Wilson's disease
5) methotrexate therapy
6) fever of unknown origin
7) porphyria cutanea tarda
8) non-Hodgkin's lymphoma
9) Hodgkin's disease
10) hepatomegaly
11) liver mass (without diagnosis)
Procedure:
1) preparation:
- complete blood count
- coagulation tests
- obtain history of anticoagulant (warfarin) or antiplatelet therapy
- stop taking aspirin, NSAIDs, anticoagulants one week prior to biopsy
- NPO 8 hours prior to biopsy
2) procedure
- liver biopsy is considered minor surgery (in hospital procedure)
- sedation
- patient supine with right hand above head
- patient must lie still
- mark outline of your liver & inject local anesthetic
- make a small incision, then insert the biopsy needle & retrieve sample of liver tissue
- patient shoud hold breath for 5 to 10 seconds while needle inserted into liver
- patient may feel pressure and dull pain
- ultrasound guidance may be useful
2) recovery
- patient on right side, pressed against a towel, for 1-2 hours
- monitor vital signs & level of pain
- must remain in hospital or go directly home & remain in bed (except to use the bathroom) for 8 to 12 hours
- avoid exertion for 1 week
- irritation of the diaphragm muscle (the pain usually radiates to the shoulder) may occur, but resolve within a few hours or days
- AVOID aspirin, NSAIDs, anticoagulants for 1 week after surgery
* percutaneous liver biopsy
Entire procedure takes about 20 minutes.
Interpretation:
- inter-pathologist agreement is better when sample size is adequate [1]
- community pathologists tend to understage fibrosis in biopsies for hepatitis C (relative to hepatopathologists) [1]
Complications:
rare
1) nicking the lung or gallbladder
2) infection
3) bleeding
4) pain
Notes:
- two other methods of liver biopsy are also available
1) laparoscopic biopsy
- indications:
- tissue samples from specific parts of the liver
2) transvenous biopsy
a) catheter inserted into external jugular vein
b) indications
1] coagulation disorder
2] ascites
Related
liver
liver disease
General
tissue biopsy
References
- Robert M et al
A comparison of hepatopathologists' and community
pathologists' review of liver biopsy specimens from patients
with hepatitis C.
Clin Gastroenterol Hepatol 2009 Mar; 7:335.
PMID: 19138761
- Tapper EB, Lok AS
Use of Liver Imaging and Biopsy in Clinical Practice.
N Engl J Med 2017; 377:756-768. August 24, 2017
PMID: 28834467
http://www.nejm.org/doi/full/10.1056/NEJMra1610570
- Liver Biopsy
https://www.niddk.nih.gov/health-information/diagnostic-tests/liver-biopsy
- Liver Biopsy Procedure
https://www.niddk.nih.gov/news/media-library/7533y