Makindo Medical Notes

About

• A liver biopsy provides essential information on the liver's structure, degree of inflammation, fibrosis, or other pathology, aiding diagnosis and guiding management.
• Performed under radiologic guidance in most cases to enhance accuracy and reduce risks.
• Patient cooperation is essential for a successful procedure, especially during the percutaneous approach.
• Avoid biopsy of a surgically resectable malignancy due to potential risks of malignancy seeding and bleeding.

Indications for Liver Biopsy

• Diagnosis and Staging: Helps identify the cause of liver disease when other tests (imaging, labs) are inconclusive, and assesses the extent of inflammation and fibrosis.
• Persistently Abnormal Liver Tests: In cases where liver enzyme levels remain elevated without clear cause.
• Suspected Chronic Liver Diseases: Assesses progression in diseases like hepatitis, autoimmune hepatitis, non-alcoholic steatohepatitis (NASH), and primary biliary cholangitis.
• Drug-Induced Liver Injury (DILI): To assess liver damage from medications.
• Suspected Liver Tumors: Biopsy is done to confirm diagnosis and type in primary or secondary (metastatic) tumors.
• Inheritable Conditions: Liver biopsy helps evaluate iron, copper levels, or other abnormalities in genetic conditions like haemochromatosis, Wilson's disease.
• Assessment for Transplant or Fibrosis: To assess liver disease severity and candidacy for transplant.

Risks of Liver Biopsy

• Bleeding: Occurs in approximately 0.6-1% of cases, with significant bleeding risk in 3 out of 1,000 cases.
• Bile Peritonitis: Rare (1 in 1,000), usually due to bile duct injury.
• Pain: Common and often mild; however, moderate to severe pain may require analgesics.
• Infection: Rare but can be serious. Monitor for signs of infection post-procedure.
• Injury to Other Organs: Rarely, needle misplacement can damage nearby organs (lungs, kidneys).

Pre-Procedure Requirements

• Laboratory Tests: FBC, PT, PTT; abnormal clotting parameters may require correction (FFP or vitamin K) prior to the procedure.
• Imaging: Pre-procedural ultrasound to assess liver position and detect any abnormalities like ascites or anatomic variations that might impact the procedure.
• Informed Consent: Explain risks, benefits, and alternatives. Ensure patient understanding and cooperation, especially for breath-holding during the procedure.

Types of Liver Biopsy Procedures

Type	Description	Indications
Percutaneous Liver Biopsy	Uses a needle inserted between the ribs, typically on the right side, guided by ultrasound to obtain liver tissue. Performed at the bedside or in a radiology suite.	Preferred for cooperative patients with normal coagulation and without ascites.
Ultrasound-Guided Biopsy	Performed in the radiology suite under real-time ultrasound guidance to ensure accurate needle placement. Ideal for patients with obesity or atypical liver position.	When liver anatomy or body habitus complicates standard percutaneous approach.
Transjugular Liver Biopsy	Performed by accessing the liver via a catheter inserted through the jugular vein, avoiding direct puncture of the liver capsule. Pressure measurements within liver veins can be taken simultaneously to assess portal hypertension.	Preferred for patients with coagulopathy, ascites, or high bleeding risk; performed in interventional radiology.

Contraindications

• Absolute: Uncooperative patient, uncorrectable bleeding diathesis (consider transjugular route), severe ascites, extrahepatic cholestasis.
• Relative: Obesity, hepatic hemangioma, previous abdominal surgery affecting liver access, infection at the biopsy site.

Post-Procedure Care

• Observe for 2-4 hours; monitor vitals and assess for pain, bleeding, or signs of infection.
• Instruct patients to rest and avoid strenuous activities for 24-48 hours.
• Assess for right shoulder pain (referred pain) as it may indicate a post-procedural complication.
• Advise on symptoms to watch for post-discharge, such as increasing abdominal pain, dizziness, or shortness of breath.

Common Findings in Liver Biopsy

• Fibrosis and Cirrhosis: Assessment of liver scarring and structural changes.
• Steatosis: Fatty liver changes, indicative of non-alcoholic steatohepatitis (NASH) or alcoholic liver disease.
• Hepatitis: Active inflammation, as seen in viral hepatitis or autoimmune liver disease.
• Granulomas: Presence may indicate tuberculosis, sarcoidosis, or primary biliary cholangitis.
• Tumors: Differentiation between benign and malignant liver lesions.

Biopsy Results Interpretation

• Histopathology: Pathologist reviews tissue sample for structural changes, fibrosis, cellular necrosis, and specific patterns of injury.
• Scoring Systems: Fibrosis or staging scores (e.g., METAVIR, Ishak) help quantify liver damage and guide treatment planning.

Liver biopsy results typically take a few days to be analyzed. Inform the patient of any additional follow-up tests or consultations needed based on results.