Liver biopsy is usually percutaneously, performed at the bedside or under ultrasound guidance. The latter is preferred because this results in a slightly lower rate of complications and at the same time allows the display of the liver and the targeted puncture focal lesions.
The liver biopsy provides information on the histological structure of the liver and detection of hepatic injury (kind and degree of each fibrosis); this information can be important not only for diagnosis but also for staging, prognosis and management. Although only a small cylinder of tissue is removed, it is representative in general even at focal lesions. Liver biopsy is usually percutaneously, performed at the bedside or under ultrasound guidance. The latter is preferred because this results in a slightly lower rate of complications and at the same time allows the display of the liver and the targeted puncture focal lesions. Indications In general, performed a biopsy for suspected liver abnormalities, which could not be identified by less invasive methods or where histopathology for staging is required (see s specified. Indications for liver biopsy *). Biopsies are particularly valuable in the diagnosis of tuberculosis or other granulomatous infiltrations and in the evaluation of graft problems after liver transplantation (ischemic injury, rejection, disturbances in the biliary tract, viral hepatitis). For years, performed serial biopsies can provide valuable information about the progression of liver disease. Indications for liver biopsy * Condition use Unexplained anomalies due to liver tests Diagnostic Alcoholic liver disease or non-alcoholic fatty liver disease diagnosis and staging chronic hepatitis (viral or autoimmune) diagnosis and staging heavy metal storage disorders (eg. As hemochromatosis, Wilson’s disease) Diagnosis Suspected rejection or other complications after liver transplantation diagnostics status of the liver donation clarification hepatosplenomegaly of unknown cause diagnosis Unexplained intrahepatic cholestasis (usually primary biliary cirrhosis or primary sclerosing cholangitis) diagnosis suspected cancer or unexplained focal lesions diagnosis Unexplained systemic diseases (eg. As fever of unknown origin, inflammatory or granulomatous disease) diagnosis (Creating a culture) Use of hepatotoxic drugs (eg., Methotrexate) Monitoring * Generally, a biopsy of suspected liver abnormalities is performed that were not identified by less invasive methods or which is required for staging a histopathology. The macroscopic and histological examination usually show already the diagnosis. Cytology (fine needle aspiration), frozen sections and cultures are also helpful in selected cases. Metals (eg., Copper on suspicion of Wilson’s disease, hemochromatosis iron at a) may be measured in the biopsy. Among the limitations of liver biopsy are sampling error Occasionally errors or uncertainty in cases of cholestasis need a qualified histopathologists (some pathologists have little experience with needle samples) Contraindications to the strict contraindications to liver biopsy include patients who are unable to keep quiet and a short exhalation during the method not endure suspicion of vascular injury (eg. as hemangioma) bleeding (eg. as INR> 1.2 despite taking vitamin K, bleeding time> 10 min.) severe thrombocytopenia (<50,000 / ml) Relative contraindications are strong anemia , peritonitis, marked ascites, quality bile duct obstruction and a subphrenic ode r right pleural or -erguss. Nevertheless, percutaneous liver biopsy is sufficiently secure to them durchfürhren outpatient basis. The mortality rate is 0.01%. Serious complications (eg. B. intra-abdominal haemorrhage, bile peritonitis, liver injuries) occur in approximately 2% of patients. Complications are usually evident within 3 to 4 h - the recommended period for patient monitoring. The alternative transjugular venous liver biopsy is more invasive than the percutaneous liver biopsy; it is reserved for patients with severe bleeding disorders. This method consists of the cannulation of the right v. internal jugular and the advancing a catheter through the inferior vena cava into the hepatic veins. A fine needle is then pierced through the wall of the hepatic vein into the liver parenchyma. The biopsy is successful in> 95% of patients. The complication rate is low, 0.2% bleeding from puncture of the liver capsule. (. Eg laparoscopy) occasionally a liver biopsy during the operation is performed; a larger, more targeted tissue sample can then be removed.