Percutaneous Liver Biopsy - Procedure, Indications, and Contraindications

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.