Indications
When a patient presents with liver abnormalities, it is not always immediately known why these abnormalities have occurred. In addition, the underlying condition of the liver may have an impact on what treatment can and should be offered to a particular patient. As a result, we are often asked to perform a biopsy on patients with liver disease. A biopsy is a procedure that is performed in order to obtain a small piece of tissue from the organ being studied. Once this tissue has been obtained, a pathologist is able to view the sample under a microscope and define the problem that the patient is facing.
Procedural Details
Most liver biopsies are performed by passing a needle through the skin and into the liver. This needle is designed in such a way that tissue can be safely obtained from the liver for further study. When a biopsy is being done for this purpose, tissue can be obtained from anywhere in the liver. A biopsy performed by Interventional Radiology is done using imaging such as ultrasound or CT for guidance. By using imaging in that way, we are able to visualize the needle as it passes through the skin and into the liver. This insures that the needle does not pass through other organs or blood vessels on its way to the liver, which increases the safety of the procedure.
Some patients with liver disease have associated abnormalities in coagulation. This means that their ability to form blood clots may be compromised, which in turn may increase the risk of bleeding in association with a biopsy. In these patients, we may suggest that we perform a transjugular liver biopsy instead of a biopsy of the liver directly through the skin. During a transjugular liver biopsy, a catheter is passed into the right internal jugular vein (which runs along the right side of the neck) and subsequently into the right hepatic vein, which is the vein draining the right lobe of the liver. Once the catheter has been placed within the right hepatic vein, a needle is advanced into the catheter. This needle is then pushed through the catheter, through the wall of the vein, and directly into the liver. The advantage of this technique is that it greatly reduces the likelihood of significant bleeding in association with this procedure since the biopsy is taking place completely within the liver.
Results
The liver is a large organ located just under the skin of the upper right side of the abdomen. In many patients, the liver may extend into the upper left side of the abdomen as well. When using ultrasound or CT for guidance, the liver is often easy to see. As a result of its size and our ability to visualize the liver, we are almost always successful in obtaining the tissue needed for pathologists to diagnose the underlying condition within the liver. Bleeding after a liver biopsy is rare, which is why these procedures are performed on an outpatient basis; after a short period of observation, patients are able to go home and recover from the procedure. Some patients may experience slight discomfort in the upper abdomen, but this is usually short-lived, lasting a day or two at most. Once the procedure has been performed, it make take a few days for pathology to complete their evaluation of the tissue. Our physicians, or the physician initially referring you for the biopsy, can review the results with you.