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HomeHealth articlesacute liver failureWhat Is a Percutaneous Liver Biopsy?

Percutaneous Liver Biopsy - Procedure, Indications, and Contraindications

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For the purpose of examination, the removal of a small part of the liver tissue is called liver biopsy. Read in detail the article below to know more about it.

Medically reviewed by

Dr. Jagdish Singh

Published At October 27, 2022
Reviewed AtOctober 27, 2022

Introduction:

The liver is one of the most essential, unique, and vital organs of the human body. The liver performs more than five hundred functions in the human body. It conducts both endocrine (a complex network of glands and organs) as well as exocrine (glands that make substances like tears, sweat, saliva, and milk) functions. Its primary function includes protein storage and production of certain enzymes; one such enzyme is bilirubin, which is most essential in the digestion process. It is a natural detoxifier.

When the functions of the liver are affected due to various underlying causes, there is a disturbance in the body and liver, leading to a diseased condition. In some such conditions, analysis of part of the liver tissue is required. A liver biopsy is recommended in such conditions. It is a procedure in which a small part of the diseased tissue from the liver is removed to analyze the underlying diseased condition.

What Is Liver Biopsy?

A procedure in which a recommended part of diseased tissue is removed from the liver of the individual for further analysis of the condition, progression of the disease, and the underlying cause or effect of the medicines given.

What Is a Percutaneous Liver Biopsy?

Percutaneous liver Biopsy is the most common minimally invasive method that uses a needle through the skin along with ultrasound guidance, with an aim to obtain the tissue sample from the diseased liver to help in the analysis, diagnosis, staging, and development of treatment effects on the liver in various disorders. It is the most preferred choice of approach and most affordable, compared to other methods of biopsy.

How Safe Is Percutaneous Liver Biopsy?

Percutaneous liver biopsy is a more common and safer procedure. It is even safer for children. Ultrasound guidance helps in minimizing the risk of complications. However, the complications are very rare.

What Are the Indications and Contraindications of Percutaneous Liver Biopsy?

Indications:

  • Any suspected liver abnormalities.

  • Diseased conditions which are not identified or which may require histopathology for staging.

  • It is a valuable method for detecting infiltrative liver disorders and clarifying allograft problems (ischemic injury, biliary tract disorders, viral hepatitis, rejection).

  • A series of biopsies are regularly done to monitor the progression of the disease.

Contraindications:

  • If the patient is anemic (very low hemoglobin levels in the blood).

  • Individuals with severe peritonitis.

  • Ascites (fluid accumulation in the abdomen).

  • Very high-grade biliary obstruction.

  • Subphrenic or right pleural effusion or infection.

  • Hemangioma (vascular lesion).

  • Hemostasis status or altered coagulation profile.

  • The inability of the patient to remain still (lying for a long time during the procedure).

  • Severe hypofibrinogenemia (disseminated intravascular coagulation).

How Do I Prepare for Percutaneous Liver Biopsy?

  • Inform your doctor if you are taking any kind of medication, especially any type of blood-thinning medications like Aspirin, Warfarin, Clopidogrel, Dipyridamole, Naproxen, or Indomethacin.

  • Inform about your current and past pregnancy issues or future plans if any.

  • Inform if you have any kind of bleeding disorders, or lung or heart conditions.

  • You will be informed by your health care provider to stop taking medications like Aspirin or any NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen, Aleve, or Naproxen a week before the procedure.

  • A set of laboratory tests would be done along with routine blood investigations like RBC (red blood cells) count, platelet count, and bleeding and clotting time.

How Is Percutaneous Liver Biopsy Done?

  • The health care provider inserts the needle into the liver through the skin with the aim of obtaining small tissues for investigation.

  • Ultrasound is used for guidance.

  • The provider may use Gelfoam in the liver to control and minimize bleeding in the gastrointestinal tract, the path where the needle is going to pass.

  • This is a harmless substance, and the body absorbs it.

  • The procedure is done under I.V sedation or G.A (general anesthesia), and the patient is asleep during the procedure.

  • The patient may be exposed to pain and discomfort at the site for several days, which would be treated by OTC (over-the-counter) medications.

  • The procedure usually takes an hour, and bandages are placed over the site of injection.

What Happens After Percutaneous Liver Biopsy?

  • You may experience pain and discomfort and may require to lie in bed for four to six hours.

  • After that, the blood CBC(complete blood count) helps in tallying any bleeding from the liver to the abdominal cavity.

  • This complication is rare; individuals with normal CBC are allowed to go home.

  • A bandage is placed at the site of the procedure and is not removed for 48 hours.

  • Keep the site of the procedure dry for 48 hours; this should be taken care of while bathing.

  • Restrictions of stressful activities are advised for a couple of days.

What Are the Conditions in Which You Should Contact Your Provider?

The conditions which may require immediate attention are:

  • Fever.

  • Shortness of breath or breathlessness.

  • Chills.

  • Dizziness.

  • Nausea and vomiting.

  • Severe pain and tenderness at the site of the procedure, shoulder, chest, or abdomen.

What Are the Other Potential Complications of Percutaneous Biopsy?

Other potential complications of this type of biopsy are:

  • Biliary peritonitis (it is a rare complication in which bile starts draining in the abdominal cavity).

  • Unintentional biopsy of other organs, like lungs, kidneys, and colon.

  • Transient bacteremia (it is most inconsequential, in which asymptomatic bacterial infection occurs).

  • Pneumothorax or hemothorax (it is also a rare complication in which the lung collapses).

  • Death (very rare one in 12000 cases).

  • Portal vein thrombosis has also been reported in rare cases after percutaneous liver biopsy.

  • Another rare complication is needle-tract seeding.

Conclusion:

Percutaneous liver biopsy is usually performed on an outpatient basis; it is the most common and is an easily done procedure with rare complications. It is safe for kids as well as adults. This procedure provides a proper histological evaluation of all kinds of liver pathologies. It is the safest procedure with the greatest diagnostic yield. It results in pain and discomfort after the procedure. However, analgesics come to the rescue in such painful conditions. It is a common and helpful procedure that can lead to better diagnosis, treatment, and analysis of staging in many malignant liver conditions.

Frequently Asked Questions

1.

What Are the Risks of Performing a Percutaneous Liver Biopsy?

The most significant risk of percutaneous liver biopsy is pain. However, bleeding and infection are some additional risks. An increased risk of bleeding following liver biopsy is associated with a number of patient, operator, and procedure-related risk factors.

2.

What Are Percutaneous Biopsy Procedures?

The procedure of a percutaneous needle biopsy is used to obtain a sample of tissue or cells for testing. The operation will be performed by an interventional radiologist. In a percutaneous liver biopsy, a needle is inserted through the skin and eventually into the liver tissue to collect a sample for use in staging, diagnosing, and/or developing therapeutic options for a range of liver diseases.

3.

What Is the Name of the Percutaneous Liver Biopsy Needle?

The most popular aspiration needle used by clinicians for biopsies and percutaneous access is referred to as a Chiba needle. This needle is used to pierce internal organs or the abdominal cavity. It helps with ultrasonography exams of the abdominal cavity and organs. 

4.

What Position Should a Patient Be in Percutaneous Liver Biopsy Procedure?

The patient should be lying face down on the bed with their right side close to the edge. The right arm of the patient needs to be above the head. The right hand is placed on the table over the head as they lie on their back. A numbing agent is applied by the healthcare professional to the place where the needle will be put. The biopsy needle is then inserted after the medical professional makes a tiny incision on the right side, not far from the bottom of the rib cage.

5.

How Is a Percutaneous Liver Biopsy Performed?

In a percutaneous liver biopsy, a needle is inserted through the skin and eventually into the liver tissue to collect a sample for use in staging, diagnosing, and/or developing therapeutic options for a range of liver diseases. 

6.

What Are the Indications for Percutaneous Liver Biopsy?

The indications for percutaneous liver biopsy include evaluation of abnormal liver test results, determination of chronic hepatitis B and C fibrosis stage and grade of inflammation, evaluation of autoimmune hepatitis, evaluation of liver tumors that do not exhibit typical imaging features of hepatocellular carcinoma, quantitative estimation of iron in hemochromatosis, quantitative estimation of copper in Wilson disease, estimation of the severity of alcoholic liver disease, and evaluation of a liver mass that does not exhibit any of these conditions.

7.

What Is Percutaneous vs Core Biopsy?

There are mainly two types of liver biopsies. A less invasive method is fine needle aspiration (FNAC), where the cells are employed for the diagnosis. When a smaller node is found, a node is located in an inconvenient location, or even when the patient has an untreatable bleeding disorder, FNAC is an appropriate procedure. In order to collect a larger sample that is typically more accurate, core biopsies are punctures done with somewhat larger needles. During a core biopsy, a needle is inserted under the skin to remove a sample of tissue from a tumor or lump. The tissue is then examined under a microscope to look for any anomalies.

8.

How Should an Individual Prepare for a Percutaneous Liver Biopsy?

For at least a week before the procedure, an individual should stop using Aspirin, Motrin, Advil, Aleve, Ibuprofen, Coumadin, Pradaxa, or any other blood thinners. And for 24 hours following the procedure, the individual should avoid lifting or bending.

9.

How Long Does a Percutaneous Liver Biopsy Take?

Even though the process only takes five seconds, the patient should plan on spending two to four hours in the office so that they may have time to prepare, follow up with the doctor, and watch for any bleeding or discomfort. After the treatment, they will need to rest at home for one to three days. After that, they will probably be able to resume working and doing the majority of their regular activities.

10.

What Is the Bleeding Risk for a Percutaneous Liver Biopsy?

With significant bleeding episodes ranging from 0.1percent to 4.6 percent and minor bleeding events occurring in up to 10.9 percent of image-guided liver biopsies, there was bleeding of some type in up to 10.9 percent of biopsies. However, it was discovered that the overall rate of bleeding was less than two percent.

11.

Will Percutaneous Liver Biopsy Hurt?

A minor side effect of a liver biopsy is pain; however, it often only causes mild discomfort. The surgical team uses an anesthetic to numb the skin prior to the surgery so the patient is pain-free. During the operation, pressure should be the only sensation. An abdominal needle is used by the doctor to do percutaneous liver biopsies. They do not require anesthesia and are the most frequent and least invasive procedures. Many of these procedures are quick and just take a few minutes.

12.

Which Type of Anesthesia Is Used for a Liver Biopsy?

At the location of the biopsy, an individual will be given a local anesthetic (numbing medication). Sedation is not typically used during liver biopsies on patients.

13.

Which Is the Most Common Type of Liver Biopsy?

It is also possible to do a liver biopsy through a transvenous or laparoscopic method, depending on the clinical situation. However, the percutaneous route is typically chosen. The most popular sort of liver biopsy, known as a percutaneous biopsy, has been carried out very frequently for many years.

14.

What Is the Recovery Position for a Liver Biopsy?

There is no set recovery position that must be kept after a transjugular liver biopsy. Although individuals could feel more at ease lying on their back or the side opposite to where the doctor placed the catheter.
Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

Tags:

acute liver failureliver biopsy
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