liver biopsy


Also found in: Dictionary, Thesaurus, Encyclopedia.
Related to liver biopsy: liver disease, liver cancer

Liver Biopsy

 

Definition

A liver biopsy is a medical procedure performed to obtain a small piece of liver tissue for diagnostic testing. Liver biopsies are sometimes called percutaneous liver biopsies, because the tissue sample is obtained by going through the patient's skin.

Purpose

A liver biopsy is usually done to diagnose a tumor, or to evaluate the extent of damage that has occurred to the liver because of chronic disease. Biopsies are often performed to identify abnormalities in liver tissues after imaging studies have failed to yield clear results.
A liver biopsy may be ordered to evaluate any of the following conditions or disorders:
  • Jaundice
  • Cirrhosis
  • Hemochromatosis, which is a condition of excess iron in the liver.
  • Repeated abnormal results from liver function tests
  • Unexplained swelling or enlargement of the liver
  • Primary cancers of the liver, such as hepatomas, cholangiocarcinomas, and angiosarcomas
  • Metastatic cancers of the liver.

Precautions

Some patients should not have percutaneous liver biopsies. They include patients with any of the following conditions:
  • A platelet count below 60,000
  • A longer-than-normal prothrombin time
  • A liver tumor that contains a large number of blood vessels
  • A history of unexplained bleeding
  • A watery (hydatid) cyst
  • An infection in either the cavity around the lungs, or the diaphragm.

Description

Percutaneous liver biopsy is done with a special hollow needle, called a Menghini needle, attached to a suction syringe. Doctors who specialize in the digestive system or liver will sometimes perform liver biopsies. But in most cases, a radiologist (a doctor who specializes in x rays and imaging studies) performs the biopsy. The radiologist will use computed tomography scan (CT scan) or ultrasound to guide the choice of the site for the biopsy.
An hour or so before the biopsy, the patient may be given a sedative to help relaxation. He or she is then asked to lie on the back with the right elbow to the side and the right hand under the head. The patient is instructed to lie as still as possible during the procedure. He or she is warned to expect a sensation resembling a punch in the right shoulder, but to hold still in spite of the momentary feeling.
The doctor marks a spot on the skin where the needle will be inserted and thoroughly cleanses the right side of the upper abdomen with an antiseptic solution. The patient is then given an anesthetic at the biopsy site.
The needle with attached syringe is inserted into the patient's chest wall. The doctor then draws the plunger of the syringe back to create a vacuum. At this point the patient is asked to take a deep breath, exhale the air and hold their breath at the point of complete exhalation. The needle is inserted into the liver and withdrawn quickly, usually within two seconds or less. The negative pressure in the syringe draws or pulls a sample of liver tissue into the biopsy needle. As soon as the needle is withdrawn, the patient can breathe normally. Pressure is applied at the biopsy site to stop any bleeding, and a bandage will be placed over it. The entire procedure takes 10 to 15 minutes. Test results are usually available within a day.

Preparation

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are known to thin the blood and interfere with clotting. These medications should be avoided for at least a week before the biopsy. Four to eight hours before the biopsy, patients should stop eating and drinking.
The patient's blood will be tested prior to the biopsy to make sure that it is clotting normally. Tests will include a platelet count and a prothrombin time. Doctors will also ensure that the patient is not taking any other medications, such as blood thinners like Coumadin, that might affect blood clotting.

Aftercare

Liver biopsies are outpatient procedures in most hospitals. After the biopsy, patients are usually instructed to lie on their right side for about two hours. This provides pressure to the biopsy site and helps prevent bleeding. A nurse will check the patient's vital signs at regular intervals. If there are no complications, the patient is sent home within about four to eight hours.
Patients should arrange to have a friend or relative take them home after discharge. Bed rest for a day is recommended, followed by a week of avoiding heavy work or strenuous exercise. The patient can resume eating a normal diet.
Some mild soreness in the area of the biopsy is normal after the anesthetic wears off. Irritation of the muscle that lies over the liver can also cause mild discomfort in the shoulder for some patients. Tylenol can be taken for minor soreness, but aspirin and NSAIDs are best avoided. Patients should call their doctor if they have severe pain in the abdomen, chest or shoulder, difficulty breathing, or persistent bleeding. These signs may indicate that there has been leakage of bile into the abdominal cavity, or that air has been introduced into the cavity around the lungs.

Risks

The risks of a liver biopsy are usually very small. When complications do occur, over 90% are apparent within 24 hours after the biopsy. The most significant risk is internal bleeding. Bleeding is most likely to occur in elderly patients, in patients with cirrhosis, or in patients with a tumor that has many blood vessels. Other complications from percutaneous liver biopsies include the leakage of bile or the introduction of air into the chest cavity (pneumothorax). There is also a small chance that an infection may occur, or an internal organ such as the lung, gall bladder, or kidney could be punctured.

Normal results

After the biopsy, the liver sample is sent to the pathology laboratory for study under a microscope. A normal (negative) result would find no evidence of cancer or other disease in the tissue sample.

Abnormal results

Changes in liver tissue that are visible under the microscope indicate abnormal results. Possible causes for the abnormality include the presence of a tumor, or a disease such as hepatitis.

Resources

Books

Brown, Kyle E., et al. "Liver Biopsy: Indications, Technique, Complications and Interpretation." In Liver Disease. Diagnosis and Management, edited by Bruce R. Bacon and Adrian M. Di Bisceglie. Philadelphia, PA: Churchill Livingstone, 2000.
Reddy, K. Rajender, and Lennox J. Jeffers. "Evaluation of the Liver. Liver Biopsy and Laparoscopy." In Schiff's Diseases of the Liver, edited by Eugene R. Schiff, et al. Philadelphia, PA: Lippincott-Raven, 1999.

Periodicals

Bravo, Arturo A., et al. "Liver Biopsy" New England Journal of Medicine 344, no. 7 (February 15, 2001): 495-500.

Key terms

Biopsy — A procedure where a piece of tissue is removed from a patient for diagnostic testing.
Menghini needle — A special needle used to obtain a sample of liver tissue.
Percutaneous biopsy — A biopsy in which a needle is inserted and a tissue sample removed through the skin.
Prothrombin time — A blood test that determines how quickly a person's blood will clot.
Vital signs — A person's essential body functions, usually defined as the pulse, body temperature, and breathing rate.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

liver biopsy

1. The percutaneous removal of tissue from the liver with a large-bore needle that captures a core of tissue.
2. A wedge of the liver obtained during laparotomy or laparoscopy.
See also: biopsy
Medical Dictionary, © 2009 Farlex and Partners

liver biopsy

The taking of a small core of liver tissue by means of a special cutting needle introduced between the lower ribs on the right side, under local anaesthesia. The method allows precise diagnosis to be made, by microscopic examination, of a wide range of liver disorders such as CIRRHOSIS, the different kinds of HEPATITIS and JAUNDICE, the damage caused by drugs, and the various forms of cancer, including LYMPHOMAS.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
The study looked at 67 children with NAFLD and found that different types of fats in the blood were associated with features of fatty liver on liver biopsy, allowing researchers to determine the presence of inflammation and scarring - also known as non-alcoholic steatohepatitis and fibrosis.
Several patient-related risk factors were identified that increase the risk of a bleeding complication following liver biopsy.
Liver biopsy showed no fibrosis in 65.3% (n=49), out of which 4 had abnormal SAPI giving a specificity of 91.8%.
In summary, although the past 6 1/2 decades have produced limited textbook and literature information on the nearly normal liver biopsy in an asymptomatic patient with elevated transaminase levels, this information all points to the conclusion that this biopsy is not associated with any liver disease.
The plaintiff's claim was that it was well-understood that hemorrhage was a potential complication of liver biopsy and that the accepted standard of care at the time required the average qualified radiologist to observe certain precautions during the procedure in order to minimize the risk of hemorrhage.
Liver biopsy always have some risk and complication as 84% have mild discomfort, 20% have pain, 0.3% have serious complication while 0.01% reported death.10 With the realization about limitation of liver bi-opsy hepatologists have increased their efforts to develop non-invasive tools for assessment of liver inflammation and fibrosis.11,12 Many research studies have proven that chronic HCV infection associated liver fibrosis is continuous dynamic as well as reversible process, needs frequent assessment for fibrosis stage before and during antifibrotic therapy.
Of these, 17 patients were excluded due to missing clinical data from the time of the follow-up biopsy, and five patients were excluded because the second liver biopsy was performed within one year of the first, leaving 60 patients for analysis.
Lindor, "Outcome of patients hospitalized for complications after outpatient liver biopsy," Annals of Internal Medicine, vol.
Caption: Figure 2: (a) H&E-stained histologic section of the liver biopsy demonstrating severe acute hepatitis characterized by a panlobular mixed inflammatory infiltrate with extensive hepatocyte necrosis (200x magnification).
The second liver biopsy, reported postmortem, revealed prominent sinusoidal histiocytosis, patchy hepatocyte necrosis, hemophagocytosis, and hemosiderosis.
Ultrasonography-guided liver biopsy (16-G Menghini needle) was performed an a 60-year-old female patient with chronic viral hepatitis.