Liver biopsy is the obtaining of a tissue sample through an invasive method that is performed using a biopsy needle. The procedure will be a definitive guide on the tissue state of the liver and would be performed only in certain instances as it involves certain amount of risk in developing complications.
As was mentioned earlier, there are several indications for a liver biopsy. These are,
Evaluating the extent of a disease state or staging Evaluate the success of the transplant or assess the rejection Diagnose suspected liver cancer When abnormal laboratory investigations needs clarifications If there are unexplained physical signs such as Jaundice In cases of infiltrative granulomatous disease…etc.
Similarly, there are contraindications as well. Some of them can be listed out as,
High INR levels indicating bleeding tendencies Low platelet counts Presence of fluid in the abdomen (ascites) Uncooperative patients…etc.
Once a decision is made to subject a patient for a liver biopsy, they need to be prepared beforehand to avoid complications. Following is a checklist of such pre-operative preparation.
Withdrawing the intake of aspirin one week prior to the test Withholding non steroidal anti inflammatory drugs three days prior to the test Explain the procedure and risks involved to the patient Correct any deficiencies in the platelet number or else the INR. Preferably fasting 6 hours before the biopsy.
With a well prepared patient, the procedure can be performed as follows.
Lay the patient in supine position with the right arm under the head Can make the patient slightly rotate towards the left side Identify the liver either by percussion or else by image guidance (Ultrasound or CT guided) Can give some light sedation in order to make the procedure comfortable. Practice sterile precautions and clean the site with betadine and lay a sterile drape. Infiltrate local anesthetic agent Inflict a small cut sing a scalpel blade Insert the biopsy needle and advance it towards the liver either manually or guided by imaging. Obtain a biopsy sample and take out the needle. Apply pressure dressing on to the biopsy site.
Following the biopsy procedure, the patient must be watched for at least 1 hour or else for 24 hours as is usually practiced. Following would guide the post-op care of these patients.
Ask the patient to be on his left side to minimize bleeding and leakage Monitor Blood pressure, respiratory rate, pulse rate…etc every 15 minutes for the first hour, every 30 minutes for the second hour and hourly for the rest of the 24 hours. If not complication at the end of 24 hours, the patient can be discharged.
Most of the complications that occur with liver biopsies will occur within the first 2 hours and thus pain and bleeding would account for most of these complications.